Septic Shock

Question 1

Patient comes in with tachycardia tachypnea hypotension no altered mental status have bounding pulses warm extremities with fever and indication on an infection foci

Answer 1

Sepsis by qsofa

Question 2

Patient need vasopressor to maintain map at 65 and lactate of more than 2 is required though fluid bolus is given what is the patient condition

Answer 2

Septic shock

Question 3

What is the initial management of septic shock

Answer 3

Iv antibiotics (pip taz ) and fluid resuscitation of 30 ml/kg both should ve started with in 1 hour its best

Question 4

What vasopressor is drug of choice for septic shock first line

Answer 4

Nor epinephrine

Question 5

What is the 2nd line drug to reduce nor epi use

Answer 5

Vasopressin 0.09 U

Question 6

Which drug is contra indicated in tachyarrhythmia patient in septic shock

Answer 6

Dopamine

Question 7

Drug used when there is no change in hypotension even though of fluid resuscitation and vasopressor

Answer 7

Dobutamine

Question 8

In which adrenergic receptor dobutamine has more effect

Answer 8

It have more effect on beta AR

Question 9

No change in hypotension this is the last and final consideration in the patient with septic shock?

Answer 9

Hydrocortisone

Question 10

When to start insulin in septic shock patient

Answer 10

Cbg BG greater than or equal to 180 mm hg 2 times

Question 11

What is the target of blood glucose in septic shock patient

Answer 11

Less than or equal to 140

Question 12

1 hr delay in antibiotics cause how much increase in mortality

Answer 12

3-7% (7.6%)

Question 13

Most common infection associated with septic shock

Answer 13

Pneumonia

Question 14

Most common type of bacteria causeing septic shock

Answer 14

Gram positive ( staph areus, strep pneumo) then gram negative (e coli, klebsiella, pseudomonus)

Question 15

Only shock in which the systemic vascular resistance drops instead of volume in side it

Answer 15

Distributive shock

Question 16

Only shock in which the cardiac out put is increased

Answer 16

Distributive shock

Question 17

What is main symptom or sign that patient entered decompensated stage of shock

Answer 17

If patient have all signs of compensation plus altered mental status

Question 18

Examination finding in low co shocks

Answer 18

Cool extremeties, weak pulses, capillary refill time more than 2 sec

Question 19

What is the indication for mechvent

Answer 19

Saco2 < 90% + ph <7.20 inadequate compensation

Question 20

What is the sensitive indicator for transfusion

Answer 20

Shock index = HR / systole bp (normal 0.5 - 0.7)
>0.9 - indication for transfusion

Question 21

Three windows to check organ dysfunction or organ hypo perfusion

Answer 21

CNS
Skin
Kidney

Question 22

When can you say there is oliguria or AKI due to sepsis or kidney has hypo perfusion

Answer 22

<0.5 ml/kg/hr in catheter bag

Question 23

Deug of choice antibiotic for septic shock

Answer 23

Pip taz 4g iv q6hrs

Question 24

Patient came in dyspneic, diaphoretic, tachypnic, pale cold extremeties, latered mental status or confused bp of < 90 mmhg distended jvp and have oliguria (may be aki) what is the patient condition

Answer 24

Caridogenic shock

Question 25

Most common cause of cardiogenic shock

Answer 25

MI plus LV dysfunction

Question 26

Mechanical cause of cardiogenic failure is always present but not in this condition

Answer 26

Takotsubo cardiomyopathy and fulminant myocarditis

Question 27

Which is most common type of MI causing cardiogenic shock

Answer 27

STEMI

Question 28

What is a strong independent predictor of mortality in cardiogenic shock during presentation

Answer 28

BLOOD GLUCOSE

Question 29

Cardiac markers elevated in cardiogenic shock sec to mi

Answer 29

CKMB
TROPININ I AND T

Question 30

Lab elevated in cardiogenic shock

Answer 30

WBC
CREATININE
C REACTIVE PROTEIN
HEPATIC TRANSAMINASES
LACTATE >2 mmol/L
ABG - hypoxemia and anion gap metabolic acidosis
Glucose
ELEVATED CARDIAC MARKERS

Question 31

WHICH INFARCT OF THE HEART IS MOST COMMONLY ASSOCIATED WITH CARDIOGENIC SHOCK

Answer 31

Anterior infarct 50%

Question 32

The main stay treatment and mortality reducer in the cardiogenic shock is

Answer 32

PCI ( percutaneous coronary intervention) > CABG ( coronary artery bypass graft )

Question 33

What should be addressed first in the cardiogenic shock

Answer 33

MAP and Bp ( 65 and 90 is ok)
Hypoxemia and anion gap metabolic acidosis must be addressed

Question 34

Highest mortality for this condition if results in cardiogenic shock around 80%

Answer 34

Ventricular septal rupture

Question 35

IABP -SHOCK SCORE for cardiogenic shock prognisis

Answer 35

Age > 73
Prior stroke
Glucose at admission >191 mg/dL
Creatinine at admission >132.6 umol/L
Atrial blood lactate >5 mmol/L
Mi after pci<3