shock

Question 1

inadequate oxygen delivery to meet metabolic demands; results in global tissue hypoperfusion and metabolic acidosis

Answer 1

shock

Question 2

what is MAP mathematically; what is the lower limit?

Answer 2

• 2/3 DBP + 1/3 SBP
• lower limit is 65

Question 3

severe sepsis w/ hypotension responsive to fluid resuscitation and perfusion abnormalities

Answer 3

septic shock

Question 4

myopathic, mechanical, arrhythmic (sinus brady, AV blocks, tachycardia)

what kind of shock

Answer 4

cardiogenic

Question 5

Signs: cool mottled skin, tachypnea, hypotension, altered mental status, narrowed pulse pressure, rales, murmur

what kind of shock

Answer 5

cardiogenic

Question 6

Component of spinal shock syndrome; hemodynamic instability seen in them w/ hypotension, bradycardia and hypothermia

what kind of shock

Answer 6

neurogenic

Question 7

Damage above T6 in sympathetic pathway; resolves in hours to days; always has systemic hypotension

what type of shock

Answer 7

neurogenic

Question 8

what type of hypovolemic shock

vomit, diarrhea, bowel obstruction, burns, environmental (dehydration)

Answer 8

non-hemorrhagic shock

Question 9

what type of hypovolemic shock

GI bleed, trauma, massive hemoptysis, AAA rupture, ectopic pregnancy, postpartum hemorrhage

Answer 9

hypovolemic

Question 10

6 ways to manage hemorrhagic shock

Answer 10

• Tourniquet
• TXA
• pelvic binder
• PRBCs, plasma platelets
• MTP

Question 11

no test needed; tx w/ needle decompression, chest tube

Answer 11

tension pneumothorax

Question 12

large heart on CXR, POCUS; tx w/ pericardiocentesis, thoracotomy

Answer 12

cardiac tamponade

Question 13

tension pneumothorax, cardiac tamponade and PE are what type of shock

Answer 13

obstructive

Question 14

what is virchows triad

Answer 14

hypercoagulable
venous injury
venostasis

Question 15

what condition has virchows triad

Answer 15

PE

Question 16

tachypnea, tachycardia, hypoxia are classic signs of what

Answer 16

PE

Question 17

test for low risk vs high risk PE

Answer 17

• low risk– d dimer
• high risk– CT test or VQ scan

Question 18

tx of PE

Answer 18

• NE
• heparin
• thrombolytics
• catheter directed tx

avoid intubation!!!!!!!!

Question 19

what is Hg goal

Answer 19

more than 10 g/dL

Question 20

Zosyn 3.375g and ceftriaxone 1g IV OR Imipenem 1g IV

when is this used

Answer 20

empiric tx of septic shock

Question 21

• 2 large bore IV
• empiric abx
• NE early
• hydrocortisone if adrenal insuff.

Answer 21

septic shock tx

Question 22

tx of RV infarct

Answer 22

fluids and dobutamine

Question 23

tx of cardiogenic shock from acute MR or VSD

Answer 23

pressors– dobutamine and nitroprusside

Question 24

first line therapy in neurogenic shock

Answer 24

atropine

Question 25

• atropine
• fluids
• steroids or pressors
• phenylephrine 100-180 until stable

Answer 25

neurogenic shock tx

Question 26

• IV epi
• steroids
• Histamine blockers
• bronchodilators
• glucagon if taking BB w/ refractory hypotension

Answer 26

anaphylactic shock tx

Question 27

SIRS criteria needs 2+ of

Answer 27

• Temp > 38 C or < 36 C
• HR > 90
• Respiratory rate > 20 resp/min or PaCO2 < 32
• WBC >12K, < 4K or > 10% bands
• Plus existence of an infection

Question 28

which two types of shock respond to fluids

Answer 28

hypovolemic & septic