Nontraumatic Shock

Question 1

State of circulatory insufficiency that creates an imbalance b.w tissue O2 supply and demand resulting in end-organ dysfx

Answer 1

Shock

Question 2

4 categories of shock

Answer 2

Hypovolemic
Distributive
Cardiogenic
Obstructive

Question 3

Type of shock (31-36%) occuring when there is dec intravascular fluid or dec blood vol

Answer 3

Hypovolemic

Question 4

Type of shock (33-50%) wherein there is relative intravascular volume depletion d/t marked systemic vasodilation

Answer 4

Distributive (e.g. septic & anaphylactic)

Question 5

Type of shock (14-29%) wherein there is inc preload, inc afterload, inc SVR, dec CO

Answer 5

Cardiogenic shock

Question 6

Most common cause of cardiogenic shock

Answer 6

Myocardial infarction

Question 7

Type of shock (1%) wherein there is dec preload, inc SVR, dec CO

Answer 7

Obstructive shock (PE, pericardial tamponade, tension PTX)

Question 8

CO is determined by:

Answer 8

HR x SV

Question 9

MAP is dependent on:

Answer 9

CO & SVR

Question 10

Normal venous lactate levels

Answer 10

<2.0 mmol/L

Question 11

Marker of impaired O2 delivery or utilization; correlates w short-term prognosis of critically-ill px

Answer 11

Elevated lactate

Question 12

Blood pressure is an insensitive marker for global tissue hypoperfusion. TRUE or FALSE?

Answer 12

TRUE because BP may not drop if there is increase in peripheral vascular resistance. SHOCK MAY OCCUR W A NORMAL BP. HYPOTENSION MAY OCCUR W/O SHOCK.

Question 13

MAP in shock

Answer 13

<65 mmHg

Question 14

Initial diagnostics to evaluate a px in shock

Answer 14

CBC w diff ct
Elec, Glucose, Ca, Mg, Phos
BUN, Crea
Serum lactate
ECG
UA
CXR
PT, PTT, INR
ABG
ALT, AST
Cultures
Cortisol lvl
Preg test
CT as indicated by hx and PE

Question 15

ABCDE tenets of shock resuscitation

Answer 15

Establishing AIRWAY
Controlling work of BREATHING
Optimizing CIRCULATION
Ensuring O2 DELIVERY
Achieving END points of resuscitation

Question 16

Tredelenburg position improve cardiopulmonary performance compared w supine position. TRUE or FALSE?

Answer 16

FALSE. It may worsen gas exchange and predispose to aspiration. Passive leg raising above level of the heart may be effective.

Question 17

Balanced crystalloids such as LRS may offer a small mortality advantage over NSS. TRUE of FALSE?

Answer 17

TRUE.

Question 18

For large fluid volumes, consider using LRS to avoid what type of acidosis assoc with PNSS?

Answer 18

hyperchloremic metabolic

Question 19

1st line vasoactive agent in most situations (++ contractility, ++++ vasoconstriction, 0 vasodilation)

Answer 19

Norepinephrine (0.5-50 mcg/min)

Question 20

Vasoactive agent w inotrope only effect

Answer 20

Dobutamine (2-20 mkm)

Question 21

At 2.5-5 mkm, dopamine acts on ___

Answer 21

cardiac contractility

Question 22

At 5-20 mkm, dopamine produces ___

Answer 22

vasoconstriction

Question 23

At 0.5-2 mkm, dopamine produces ___

Answer 23

vasodilation

Question 24

Pure alpha-agonist; used in px w shock w tachycardia or supraventricular arrhythmias

Answer 24

Phenylephrine (10-200 mcg/min)

Question 25

Vasoactive agent w/c is b1 agonist but in large doses w some b2 and a1 effect

Answer 25

Dobutamine