Shock

Question 1

Define Shock

Answer 1

The sate of inadequate tissue perfusion leading to hypoxia and cell death. Can be compensated (doesn’t present too bad) or decompensated (patient looks like they’re going to die)

Question 2

Path of Septic shock

Answer 2

infection => bacteremia => SIRS/sepsis => shock

Question 3

Define SIRS/Sepsis

Answer 3

Systemic Inflammatory response to infection. Vitals include T > 38, RR > 20, HR >90, WBC > 12. Very sensitive, not specific.

Question 4

Treatment of Sepsis

Answer 4

ANTIBIOTICS. Early goal directed therapy (supplemental O2, early intubation, treat dehydration, monitor central venous O2 levels, etc)

Question 5

Who gets septic shock

Answer 5

everyone. However immunocompromised are at higher risk (diabetes mellitus, medicated, hospitalized, aspelnic) as well as extremes of age.

Question 6

List the different types of shock (5)

Answer 6

Septic shock, hemorrhagic shock, neurogenic shock, anaphylaxis shock, cardiogenic shock.

Question 7

hemorrhagic shock: do you need to have hypotention to be defined as shock?

Answer 7

NO. Class I and II of hemorrhagic shock do not have hypotension, yet they are still considered to be in hemorrhagic shock (losing >750 mL blood or 750-1500 mL blood).

Question 8

How do you treat hemorrhagic shock?

Answer 8

Find bleeding. stop the bleeding. Reverse coagulopathies (warfarin), replace blood and support patients.

Question 9

Do you want to bring patients in hemorrhagic shock back to normal blood pressure? What do you use to fluid resuscitate?

Answer 9

NO. want hypotensive resuscitation for traumas. Bringing them up to normal BP can break loose some clots and cause more bleeding. Do NOT use crystaloid fluid to resuscitate - will dilute clotting factors.

Question 10

What are the key signs of Anaphylaxis shock?

Answer 10

Diffuse urticaria: rash looking like raised fluid filled wheals.

Angioedema: swelling of lips. Worry about other parts of the airway swelling as well.

Others: abdominal pain, bronchospasm, rhinorrhea, conjunctivitis, hypotention

Question 11

Difference between Anaphylaxis shock and Anaphylactoid shock?

Answer 11

Anaphylaxis requires previous exposure to sensitizing agent, typically IgE dependent mast cell basophil release.

Anaphylactoid is Non-IgE mediated, and does not require a sensitizing exposure.

Question 12

Causes of anaphylaxis

Answer 12

1. Antibiotics (b-lactams)
2. Insects
3. Food

Question 13

Anaphylaxis treatment

Answer 13

EPINEPHRINE there are NO absolute contraindications

others: airway (intubate early), fluid resuscitation, steroids, antihistamines (H1 and H2), Tx bronchospasm).

Question 14

Define Neurogenic shock. causes? common sypmtoms?

Answer 14

Disruption of sympathetic outflow.
causes: blunt trauma (c-spine),

Symptoms: unopposed vagal tone, hypotention, bradycardia.

Question 15

Is neurogenic shock = spinal shock?

Answer 15

NO. Spinal shock is total loss of spinal reflex activity at/below injury level.

Question 16

How do you treat neurogenic shock?

Answer 16

Assume hemorrhage: even with bradycardia and treat

Cord damage is done: try to stop secondary injury.

Fluids

Pressors

Question 17

Define Cardiogenic shock. Causes?

Answer 17

Decreased cardiac output depsite adequate volume: leading to tissue hypoperfusion.

Most common cause: MI
Others: chordae rupture, decompensated CHF, myocardidits, sepsis, toxins.

Question 18

How do you diagnose cardiogenic shock? Treat?

Answer 18

Dx: EKG, Echo, CXR, Labs, monitoring.
Tx: ABC support, reperfusion of MI, intraaortic balloon pump, tox treatment.

Question 19

Do Pressors improve meaningful outcomes? When are they useful/not useful?

Answer 19

NO - they do not improve meaningful outcomes. Only use for anaphylaxis. Pressors does not treat underlying derangements.