Resuscitation: Shock Flashcards
Resuscitation goals:
CVP: ___ mmHg
MAP: ____ mmHg
UO >___ cc/kg
SCvO2 > __ %
CVP: 8-12
MAP: 65-90
UO >0.5 cc/kg
SCvO2 > 70 %
Base deficit value that represents early shock
> -2 meq/L
Lactic acidosis = serum lactate >__ mmol/L
> 4 mmol/L
Only type of shock that has WIDE pulse pressure
Distributive
Only type of shock that has HIGH ScVO2/ tissue perfusion
Distributive
2 types of schock that has high CVP
- Cardiogenic
- Obstructive
Indications for pRBC transfusion in hemorrhagic schock
No response to 2 fluid boluses
Ongoing hemorrhage
Impending cardiovascular collapse
Transfuse platelets when plt count < ____/uL
50,000
Transfuse ___ for px in Warfarin with an elevated INR & significant bleeding, liver failure
FFP
Fluid deficit in pedia:
% fluid loss x weight = L deficit
1/2 to be given for the 1st 8 hours then the remainder for the next ___ hrs
16
Pedia computation for daily maintenance fluids (Halliday-Segar)
1st 10 kg: 100 mL/kg/day
Next 10-20 kg: 50 mL
20-70 kg: 20 mL
1st line drug for dysrrhythmias complicating cardiogenic shock
Amiodarone
PDE inhibitor with positive inotropic and vasodilatory effect useful in cardiogenic shock d/t pulmo hypotension
Milrinone
B-adrenergic agonist that improves myocardial contractility and augments diastolic coronary blood flow
Dobutamine
a>b adrenergic causing inc SVR w smaller increased in inotropy & chronotropy
Norepinephrine
Inotrope that has both a & b adrenergic effect at high doses (15 mkm), hence increasing inotropy and SVR
Dopamine
5 major causes of distributive shock
- Sepsis/ SIRS
- Rewarming in severe hypothermia
- Neurogenic shock
- Endocrinologic crisis (adrenal crisis, thyroid storm)
- Anaphylaxis
Antibiotics must be administered within __ of identification of septic shock
1 hr
Empiric antibiotic for neonates
Ampicillin + cefotaxime
Empiric antibiotic for children
Vancomycin + cefotaxime
Empiric antibiotic for adult
Vancomycin + 3rd/4th gen cephalosporin/ Piptaz/ Carbapenems
SIRS is defined by 2 or more of the ff: __
HR >90
Temp <36 or >38C
RR >20 / PaCO2 <32
WBC <4,000 or >12,000 or >10% immature neutrophils
In refractory hypotension, what steroid can be considered to treat relative adrenal supression
Hydrocortisone 200-300 mg/d
Syndrome associated with colonization of exotoxin producing strain of S aureus; assoc w tampon use, surgical wounds, nasal packing or burns
Staphylococcal toxic shock syndrome
