Sepsis/shock

Question 1

Three parts of cellular respiration

Answer 1

glycolysis,the citric acid cycle, and election transport chain

Question 2

Mircrocirculation

Answer 2

the nexus between the arterioles and venules consisting of the capillaries the course between cells of the various orgons

Question 3

% of oxygen bound, locations

Answer 3

97% hemoglobin

3%plasma

Question 4

Oxygen carrying capacity formula

Answer 4

HgB 1.39= oxygen carrying capacity

Question 5

Cao2 formula

Answer 5

Arterial oxygen content(Cao2) =(HgBx1.39xSao2)+(0.0031xPao2)

Normal value= 17-20 mL/100 mL aterial blood

Question 6

DO2

Answer 6

Oxygen delivery
Combines arterial oxygen content with cardiac output
DO2=COxCao2

Question 7

VO2

Answer 7

Oxygen consumption
VO2= COxHgbx13.9x(Sao2-Svo2)
Normal value 180-280 mL/min

Question 8

ERo2

Answer 8

Oxygen extraction ratio
Vo2/Do2
Normal Value 25%

Question 9

Factors that affect transport of blood

Answer 9

blood volume,viscosity, and arterial elasticity

Question 10

Systolic blood pressure relies on

Answer 10

Cardiac output(the force and volume of bloodejected from the ventricles during systole

Question 11

Cardiac output is dependent on

Answer 11

Heart rate and the components of stroke volume ( preload,afterload, and contractility

Question 12

Diastolic blood presszure depends on

Answer 12

peripheral resistance, which is determined by ateriolar vasoconstriction

Question 13

2,3 DPG

Answer 13

2,3 biphosphglycerate

a chemical that bings to deoxygenated Hgb which helps red blood cells relase oxygen

Question 14

4 stages of shock

Answer 14

1,Initial (early shock)
2.Compensatory
3, decompnsatory or progressive
4. irreversible or refractory

Question 15

Neural Compensation

Answer 15

Decreased cardiac output—-> Decreased blood pressure—->Sympathetic nervous system activation—->
Blood vessels (constriction of Integumentary system, renal system, and GI tract)
Skeletal muscle dilation,
coronary arteries dilation,
sweat glands diphoresis
heart increased rate
lungs increased rate and depth of respiration
pupils dilation

Question 16

Hormonal compensation

Answer 16

Kidney
Decreased renal blood flow—->renin production—> release of aldosterone—-> sodium and water retention

Hypothalamus

1. Posterior pituitary—-> release of ADH—-> sodium and water retention
2. Anterior pituitary—-> release ofadrencorticotropic hormone—-> relase of cortisol—–> hyperglycemia
3. Adrenal medulla—-> release of epi and norepi

Question 17

Chemical compensation

Answer 17

Decreased cardiac output—-> decreased blood flow to lungs—–> increased physiologic dead space—->decreased arterial Pao2—->stimulates chemoreceptors—-> increased rate and depth of respirations/ increased PaCO2, increased sympathetic response—->Respiratory alkalosis—-> cerebral vasoconstriction—> cerebral ischemia—-> decreasedlevel of consciousness

Question 18

Compensatory mechanisms are divided into

Answer 18

neural, hormonal, and chemical mechanisms

Question 19

Capillary pressure is dependent on

Answer 19

adequate MAP

Question 20

Marked change in hydrostatic pressure in microcirculation during progressive shock leads to

Answer 20

blood pooling due to increased hydrostatic pressure, and edema and third spacing (mottled skin)

Question 21

CVP is a direct measure of

Answer 21

Right atrial pressure and an indirect measure of preload of the right ventricle

Question 22

PCWP reflects

Answer 22

Left atrial pressure

Question 23

Primary MODS

Answer 23

Results from direct insult such as trauma

Question 24

Secondary MODS

Answer 24

is the more common cause of organ failure and is slower, more progressive insult to organs
Frequently results from the sepsis cascade

Question 25

Mortality rates with MODS

Answer 25

2 failing organs are 22 to 33% chance of recovery | 4 or more organs the mortality rate is nearly 100%

Question 26

Renal failure increases the risk of death by what percent

Answer 26

30%

Question 27

Classifications of shock

Answer 27

Cardiogenic, hypovolemic, and distributive

Question 28

Cardiogenic shock

Answer 28

failure of the heart to pump blooc effectively A sustained systolic blood pressure of 80 to 90 mmhg for greater then 30 min A MAP of 30 mmhg below baseline or less then 65 mmhg over time a severe reduction in cardiac index(18mmhg or right ventricular fillingpressure of >10 to 15 mmhg

Question 29

5 major determinants of myocardial oxygen consumption

Answer 29

contractility,preload,wall tension,afterload,and heart rate

Question 30

Primary management of cardiogenic shock is focused on

Answer 30

enhancing CO while decreasing left ventricular workload

Question 31

Findings ins Left ventricular heart failure

Answer 31

``` Heart rate: Increased Blood pressure:WNL initial, decreased with severity Pulse pressure:narrow CVP:WNL PCWP:increased CO/CI:decreased SVR:increased Svo2:decreased Urinary output:decreased JVD:absent Heart sounds:S3 Edema:pulmonary ```

Question 32

Findings in right ventricular heart failure

Answer 32

``` Heart rate: Increased Blood pressure:WNL initial, decreased with severity Pulse pressure:narrow CVP: Increased PCWP:decreased CO/CI:decreased SVR:increased Svo2:decreased Urinary output:decreased JVD:present Heart sounds:normal Edema:Peripheral ```

Question 33

Findings in Biventricular Heart Failure

Answer 33

``` Heart rate: Increased or decreased Blood pressure:Decreased Pulse pressure:narrow CVP: Increased PCWP:Increased CO/CI:decreased SVR:increased Svo2:decreased Urinary output:decreased JVD:present Heart sounds:S3 or S4 Edema:systemic ```

Question 34

Findings in hypovolemic shock

Answer 34

``` Heart rate: Increased Blood pressure:WNL initial, decreased with severity Pulse pressure:narrow CVP: decreased PCWP:decreased CO/CI:decreased SVR:increased Svo2:decreased Urinary output:decreased JVD:flat Hct:Decreased with hemmorage/ increased with dehydration ```

Question 35

Class I hemmorage 70 kg male

Answer 35

``` blood loss(ml):30 Fluid replacement:crystalloid ```

Question 36

Class II hemmorage 70 kg male

Answer 36

``` blood loss(ml):750-1500 %blood loss:15-30 HR:.>100 blood pressure:Normal pulse pressure:Narrow Cap Refill:delayed RR:20-30 CNS:mildly anxious Skin:cool,pale Urine output:20-30 Fluid replacement:crystalloid ```

Question 37

Class III Hemmorage 70 kg male

Answer 37

``` blood loss(ml):1500-2,000 %blood loss:30-40 HR:>120 blood pressure:Low pulse pressure:Narrow Cap Refill:delayed RR:30-40 CNS:anxious and confused Skin:cold,pale, moist Urine output:5-15 Fluid replacement:crystalloid and blood ```

Question 38

Class IV hemmorage

Answer 38

``` blood loss(ml):>2000 %blood loss:>40 HR:>140 blood pressure:low pulse pressure:very narrow Cap Refill:absent RR:>35 CNS:confused and lethargic Skin:cold,cyanotic Urine output:minimalor none Fluid replacement:crystalloid and blood ```