Shock

Question 1

What is shock?

Answer 1

Hypoperfusion to vital organs. NOTE: not defined by low blood pressure though it happens a lot

Question 2

When can you have normal BP and still be in shock?

Answer 2

If very high end organ resistance (think sympathetics stopping blood to kidneys)

Question 3

Why would organs not be getting enough oxygen during shock? (4 possible reasons)

Answer 3

1. Oxygen is displaced. 2. Decreased O2 carrying capacity. 3. Decreased Pulmonary Funciton. 4. Decreased Blood Flow

Question 4

Low O2 causes loss of cell membrane integrity. What are the 5 labs you would see deviation from normal with hypoxic effects of shock?

Answer 4

Hyperkalemia, Hyponatremia, Metabolic Acidosis, Hyperglycemia, Lactic Acidosis

Question 5

What are the 4 stages in the shock scale progression?

Answer 5

1. Concern. 2. Systemic Inflammatory Response Syndrome (SIRS), 3. Multi-Organd Dysfunction Syndrome (MODS), 4. Death

Question 6

What is the (systemic inflammatory response syndrome) SIRS criteria?

Answer 6

At least 2 of the following: High or Low Temp, Tachycardia, Tachypnea, PaCO2 is less than 32, WC count less than 4 or more than 12 thousand. It is like septic disorder without the infection. Note: Sepsis and SIRS can progress to MODS.

Question 7

There are 4 phases of shock. Order them.

Answer 7

1 just needs more volume and not too scary. 4 is very bad. Just know that he said in class.

Question 8

What are typical 5 findings in shock? (note the 2 most important first)

Answer 8

ALTERED MENTAL STATUS, Metabolic ACIDOSIS, hypotension, cool clammy skin (unless systemic vascular resistance, then skin is warm and flushed), low urine output.

Question 9

How do you monitor shock patients?

Answer 9

Level of alertness and urine output are most important. Lactic acid, CXR, BP, O2 sats, Hgb, ABGs (arterial blood gas) are other things and kinda obvious.

Question 10

What is the Shock Index?

Answer 10

SI is Heart Rate/Systolic Pressure. Normal should be 0.5-0.7. If 1 or more, you see increased mortality.

Question 11

How do you measure capillary wedge presure? And what is it?

Answer 11

Swan Ganz Catheter measures it and can use it to calculate LV pressure, but it is found to increase mortality.

Question 12

List the 4 types of shock.

Answer 12

Cardiogenic, Distributive/dissociative, Extracardiac, Hypovolemic.

Question 13

What is cardiogenic shock?

Answer 13

Decreased output from heart. Can be from MI, arrhythmia, outflow issues: stenosis or hypertrophy, mitral regurge, VSD

Question 14

What is distributive/dissociative shock?

Answer 14

Initially high cardiac output, but then decreased systemic vasc resistance happens and you get poor distribution. Happens with septic shock, spinal cord injury, CO, or anaphylaxis from gram + exotoxin or G- endotoxin

Question 15

What type of shock can be caused by spinal injury?

Answer 15

Distribuitive or Hypovolemic

Question 16

What is extracardiac shock?

Answer 16

Outflow obstruciton with no problem of heart. Example is PE, tampanade, COPD resulting in pulmonary hypertesnion.

Question 17

What is hypovolemic shock?

Answer 17

Loss of fluid so low preload. Diarrhea, vom, sweating, hemorrhage, burns, spinal injury, 3rd spacing like edema or ascites

Question 18

4 types of treatment of shock?

Answer 18

1st thing to do is volume replacement.

Then vasopressors like catecholamines, dopamine, dobutamine can be used if others don’t work.

Hypothermia if post cardiac arrest patient.

Then specific treatments depending on cause like tPA, anticoag, antibiotics…

Question 19

He went over cases, I don’t know if relevant for cards.