Shock

Question 1

Define sepsis

Answer 1

Life threatening organ dysfunction as result of dysregulated host response to infection

Question 2

Define septic shock criteria (3)

Answer 2

• presence of hyperlactataemia (>2mmol/L)
• need for vasopressors to maintain map > 65
• despite volume resuscitation

Question 3

Name the 4 end targets and timing for patients presenting with septic shock

Answer 3

• Central venous oxygen saturation 70% or more
. Map 65 or more
. CVP 8-12
• urine output 0,5 or more ml/kg/ h
Within 6 hours!

Question 4

What is given for DVT prophylaxis in shock?

Answer 4

Clexane - low molecular weight heparin lmwh 0,5ml/kg

Question 5

Name 2 types of hypovolaemic shock and 3 examples each

Answer 5

• Haemorrhagic: trauma, upper or lower git bleed, aneurysms, obstetric or gynaecological
• non - haemorrhagic; git losses by vomit/diarrhea, skin losses by burns, renal losses by osmotic diuresis, third space losses by pancreatitis/bowel obstruction

Question 6

Name and describe the 4 stages of haemorrhagic shock

Answer 6

• stage 1: 0-15% blood loss: 0-750ml in ideal man
• stage 2: 15-30% -750 ml to 1,5 L
• stage 3:30-40 %–1,5 -2 L
• stage 4: > 40% - 2l (dead)

Question 7

How assess and classify patient’s response to initial treatment of shock (6)

Answer 7

Assess
1. Physiological parameters: vitals
2. Base deficit and lactate
3. Urine output

Response
1. Rapid
2. Transient
3. Minimal/none

Question 8

What are the principles of damage control /controlled/ balanced/ hypotensive resuscitation. /permissive hypotension? (3)

Answer 8

• Target SBP ≥ 70
• use of blood products in balanced ratio rather than fluids for volume replacement
• rapid and early correction coagulopathy with component therapy and repair/surgery (damage control surgery )

Question 9

Bp target for haemorrhagic shock?

Answer 9

≥70

Question 10

MAP target for neurogenic shock?

Answer 10

Map ≥ 80-90

Question 11

MAP target for severe TBI?

Answer 11

Map ≥ 80

Question 12

Name 3 types cardiogenic shock and 3 examples of each

Answer 12

1 Cardiomyopathic
• mi
• underlying dilated cardiomyopathy
• myocarditis
• myocardial depression in septic shock

2. Arrhythmic
   • fast af or supra ventricular. tachycardia
   . Ventricular tachycardia
   • 3rd degree heart block
3. Mechanical
   • severe aortic or mitral insufficiency
   • atrial myxomas
   • ventricular wall aneurysm

Question 13

What is obstructive shock? Name 5 causes

Answer 13

Extracardiac causes of pump failure causing reduced cardiac output
• tension pneumothorax
• pericardial tamponade
. Constrictive pericarditis
. Abdominal compartment syndrome
• pulmonary embolism

Question 14

What is distributive shock?

Answer 14

Pathological vasodilation causing relative hypovolaemia and reduced preload, thus reducing cardiac output.

Question 15

Name 6 causes distributive shock

Answer 15

• Septic shock!
• sirs
• anaphylactic shock
• neurogenic shock
• drug and toxin induced shock
• endocrine shock- addisonian crises

Question 16

Early sign of hypovolaemic shock?

Answer 16

Collapse of neck veins

Question 17

Name the 3 cardinal signs of shock

Answer 17

• Tachycardia
. Hypotension
• peripheral cyanosis

Question 18

Which agent should be given to patient with cardiogenic shock to improve cardiac’s output and renal perfusion

Answer 18

Dobutamine (inotrope)