OnlineMedEd: Intern Content - "Shock III"

Question 1

Review the SIRS criteria.

Answer 1

• HR > 90
• RR > 20 or PaCO2 < 32
• Temp > 38 or < 36
• WBC > 12 or < 4

Question 2

What workup should you do for someone in SIRS with a possible infectious source?

Answer 2

• UA and urine culture
• Blood cultures
• Chest x-ray

Question 3

Severe sepsis responds to ___________.

Answer 3

fluids

Question 4

In septic shock, titrate CVP to __________.

Answer 4

10-12 mm Hg

Less than 10 indicates that the person is hypovolemic. Greater than 12 indicates hypervoluemia.

Question 5

In septic shock, aim for a goal mixed venous O2 content of _________.

Answer 5

> 70%

Question 6

How do you do a leg lift?

Answer 6

• First, you need to have an arterial line in to get extremely accurate BP measurements.
• Second, have the person lie flat for at least five minutes.
• Third, lift both of the person’s legs. If the BP increases by ≥10 mm Hg, then this is a positive test.

Question 7

In what order do you give pressors in septic shock?

Answer 7

1) Norepinephrine
2) ADH
3) Epinephrine

Four pressor agents is a dire situation. Once you get to this point, it is time to discuss goals of care and realistic expectations with the family.

Question 8

Explain how distributive shock affects central venous oxygen saturation?

Answer 8

In distributive shock, the entire system dilates. This effectively makes your whole body like an arteriovenous fistula with high flow. Because the flow is so high, less oxygen is taken up by the tissues. This increases SvO2.

Question 9

How does a low hemoglobin affect SvO2?

Answer 9

Low hgb decreases SvO2

If you decrease the hgb carrying oxygen and keep the oxygen extraction the same, then the percent O2 saturation returning to the heart (represented by SvO2) decreases.

Question 10

An SvO2 < 70% indicates something other than ___________.

Answer 10

sepsis (because distributive shock leads to increased SvO2)