Organ System Dysfunction

Question 1

What are the effects on the CNS in shock and what testing would be ordered

Answer 1

Ischemic injury can occur at a MAP < 50-60
EEG should be ordered

Question 2

Cardiovascular effects from shock

Answer 2

Tachycardia but with hemorrhage can be paradoxical bradycardia
SVT and ventricular ectopy
Decreased contractility
Hypotension
Ischemia

Question 3

Respiratory effects of shock

Answer 3

Early respiratory failure is caused by increased workload and diaphragmatic muscle impairment
Increased min volume leads to hypocapnea and respiratory alkalosis
Increased min volume and decreased CO lead to VQ mismatch
ARDS

Question 4

Shock effects on renal system

Answer 4

Decreased UO (up to 1-2 days later with increased crt, urea, and K)
Renal hypoperfusion w/or w/o ATN

Question 5

What are the urine sediment, sodium, osmolality, FENA, and urine/plasma crt ratio in AKI without ATN

Answer 5

Sediment: benign
Sodium: <20
Osmo: >450
FENA: <1%
Urine/Plasma crt: >40

Question 6

What are the urine sediment, sodium, osmolality, FENA, and urine/plasma crt ratio in AKI with ATN

Answer 6

Sediment: hematuria
Sodium: >40
Osmolality: <350
FENA: >1%
Urine/Plasma Crt: <20

Question 7

GI effects of shock

Answer 7

Spleen: vasoconstriction
Ileus, gastritis, pancreatitis, cholecystitis, hemorrhage, enteric ischemia
Liver: shock liver, lobular injury, transaminitis resolving within 3-10 days

Question 8

What is the difference between DIC and liver failure

Answer 8

Factor 8 is normal or increased in liver failure

Question 9

What is the most common cause of coagulation defects in shock

Answer 9

Dilutional thrombocytopenia