Shock

Question 1

Central Venous Pressure (CVP)
Where? Measures what?
Normal?

Answer 1

Right atrium Right heart function.

2-8mmHg

Question 2

What decreases CVP? (2)

Answer 2

Dehydration, distributive shock

Question 3

What increases CVP? (3)

Answer 3

Cardiac tamponade, fluid overload, cardiogenic shock

Question 4

Pulmonary Artery Pressure (PAP)
Measures?
Normal

Answer 4

Systolic and diastolic BP in pulmonary artery

15-25/5-15

Question 5

What increases PAP? (5)

Answer 5

Hypervolemia, pulmonary HTN, LV failure, mitral stenosis or regurgitation

Question 6

What decreases PAP? (1)

Answer 6

Hypovolemia

Question 7

Pulmonary Capillary Wedge Pressure (PCWP)
Also called?
Measures?
Normal?

Answer 7

Pulmonary Artery Occlusion Pressure (PAOP)
Left ventricle pressure at end-diastole (maximum stretch)
6-12 mmHg

Question 8

What increases PCWP? (2)

Answer 8

Increased fluid, decreased elasticity

Question 9

What decreases PCWP? (1)

Answer 9

Hypovolemia

Question 10

What does PCWP reflect?

Answer 10

Tendency to develop pulmonary edema

Question 11

Cardiac Output (CO)
Measures?
Normal

Answer 11

HR x SV Amount of fluid in liters heart pumps out

4-8 L/min

Question 12

What increases CO? (2)

Answer 12

Inotropic agents, excess fluid

Question 13

What decreases CO? (2)

Answer 13

Decreased contractility, hypovolemia

Question 14

Cardiac Index (CI)
Measures?
Normal?

Answer 14

CO/BSA

2.5-4 L/min

Question 15

Systematic Vascular Resistance (SVR)
Measures?
Normal?

Answer 15

Resistance of systemic circulation against left ventricle
=(MAP-mean CVPx80)/CO
800-1200 dynes/sec/cm-5

Question 16

Mixed venous oxygen saturation (SVO2)
Measures?
Normal?

Answer 16

Venous O2 by pulmonary artery catheter

60 -80%

Question 17

What increases SVO2? (4)

Answer 17

Decreased tissue extraction of O2, sepsis, hypothermia, oxyhemoglobin curve to left

Question 18

What decreases SVO2? (4)

Answer 18

Increased tissue extraction of O2, anemia, fever, increased work of breathing

Question 19

What is shock?

Answer 19

Clinical syndrome of hypotension, acidemia, and organ hypoperfusion

Question 20

Hypovolemic shock

Answer 20

Loss of >20% circulating volume (includes DKA)

Question 21

Cardiogenic shock

Answer 21

Acute pump failure: MI

Question 22

Distributive shock (3)
Types (3)

Answer 22

Vasodilation, reduced PVR, loss of capillary integrity

Septic, anaphylactic, neurogenic

Question 23

qSOFA (3)

Answer 23

SBP<100, RR>22, GCS<15

Question 24

Septic shock (distributive)

Answer 24

Hypovolemia d/t altered vascular tone

Question 25

Anaphylactic shock (distributive)

Answer 25

IgE mediated Needs epi

Question 26

Neurogenic shock (distributive)

Answer 26

Loss of vasomotor tone d/t spinal injury

Question 27

Obstructive shock

Examples? (2)

Answer 27

Low CO d/t impaired cardiac filling

Massive PE, tension pneumo