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Emergency Medicine > Resuscitation: Shock > Flashcards

Resuscitation: Shock Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Resuscitation goals:
CVP: ___ mmHg
MAP: ____ mmHg
UO >___ cc/kg
SCvO2 > __ %

A

CVP: 8-12
MAP: 65-90
UO >0.5 cc/kg
SCvO2 > 70 %

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2
Q

Base deficit value that represents early shock

A

> -2 meq/L

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3
Q

Lactic acidosis = serum lactate >__ mmol/L

A

> 4 mmol/L

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4
Q

Only type of shock that has WIDE pulse pressure

A

Distributive

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5
Q

Only type of shock that has HIGH ScVO2/ tissue perfusion

A

Distributive

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6
Q

2 types of schock that has high CVP

A
  1. Cardiogenic
  2. Obstructive
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7
Q

Indications for pRBC transfusion in hemorrhagic schock

A

No response to 2 fluid boluses
Ongoing hemorrhage
Impending cardiovascular collapse

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8
Q

Transfuse platelets when plt count < ____/uL

A

50,000

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9
Q

Transfuse ___ for px in Warfarin with an elevated INR & significant bleeding, liver failure

A

FFP

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10
Q

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

A

16

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11
Q

Pedia computation for daily maintenance fluids (Halliday-Segar)

A

1st 10 kg: 100 mL/kg/day
Next 10-20 kg: 50 mL
20-70 kg: 20 mL

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12
Q

1st line drug for dysrrhythmias complicating cardiogenic shock

A

Amiodarone

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13
Q

PDE inhibitor with positive inotropic and vasodilatory effect useful in cardiogenic shock d/t pulmo hypotension

A

Milrinone

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14
Q

B-adrenergic agonist that improves myocardial contractility and augments diastolic coronary blood flow

A

Dobutamine

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15
Q

a>b adrenergic causing inc SVR w smaller increased in inotropy & chronotropy

A

Norepinephrine

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16
Q

Inotrope that has both a & b adrenergic effect at high doses (15 mkm), hence increasing inotropy and SVR

A

Dopamine

17
Q

5 major causes of distributive shock

A
  1. Sepsis/ SIRS
  2. Rewarming in severe hypothermia
  3. Neurogenic shock
  4. Endocrinologic crisis (adrenal crisis, thyroid storm)
  5. Anaphylaxis
18
Q

Antibiotics must be administered within __ of identification of septic shock

A

1 hr

19
Q

Empiric antibiotic for neonates

A

Ampicillin + cefotaxime

20
Q

Empiric antibiotic for children

A

Vancomycin + cefotaxime

21
Q

Empiric antibiotic for adult

A

Vancomycin + 3rd/4th gen cephalosporin/ Piptaz/ Carbapenems

22
Q

SIRS is defined by 2 or more of the ff: __

A

HR >90
Temp <36 or >38C
RR >20 / PaCO2 <32
WBC <4,000 or >12,000 or >10% immature neutrophils

23
Q

In refractory hypotension, what steroid can be considered to treat relative adrenal supression

A

Hydrocortisone 200-300 mg/d

24
Q

Syndrome associated with colonization of exotoxin producing strain of S aureus; assoc w tampon use, surgical wounds, nasal packing or burns

A

Staphylococcal toxic shock syndrome

25
Q

Syndrome caused by exotoxins produced by GAS in skin & soft tissue infections

A

Streptococcal toxic shock syndrome

26
Q

Antibiotic regimen for toxic shock syndromes (should cover MRSA & GAS)

A

B-lactam + clindamycin + vancomycin

27
Q

Neurogenic shock occurs on acute spinal injury above the level of ___

A

T5

28
Q

1st line inotrope for neurogenic shock (to maintain MAP 85-90)

A

Dopamine

29
Q

Colloid indicated for spontaneous bacterial peritonitis & for px receiving lareg-volume paracentesis

A

Albumin 25%

30
Q

Maximum dosage of dextrans

A

20 mL/kg

31
Q

1st line inotrope for cardiogenic shock

A

Dobutamine

32
Q

Surviving Sepsis Guidelines recommend transfusing for Hgb value < __

A

7

33
Q

Type of shock that presents with bradycardia

A

Neurogenic shock

34
Q

There is currently no role for high-dose steroids in spinal cord injury (SCI). TRUE or FALSE?

A

TRUE

35
Q

After initial IV crystalloid bolus & infusion of 2 units of pRBC, what is the recommended ratio of RBC:plasma:platelet?

A

1:1:1

36
Q

Most sensitive PE for assessing patient’s ability to protect his airway

A

Ability to speak

36
Q

Consider transcutaneous pacing on patients with HR <__bpm

A

40

Emergency Medicine (1 decks)

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