Shock

Question 1

Hypovolemic: signs

Answer 1

LOW pre-load / PCWP

low CO/CI

high SVR

Question 2

Cardiogenic: signs

Answer 2

high pre-load / PCWP

LOW CO/CI

high SVR

Question 3

Septic: signs

Answer 3

low pre-load / PCWP

high/low CO/CI

LOW SVR

Question 4

Overall Tx

Answer 4

Hypovolemic: IV fluids

Cardio: Inotropes

Septic: Pressors

Question 5

Goals

Answer 5

MAP 65+

PCWP 6-12

CI 2.2+

Question 6

Hypovolemic: tx

Answer 6

-Crystalloids (doc,1-2L)
-Colloids
-Blood (low hgb/hct)
-Pressors (refractory)

Question 7

Cardiogenic: etiologies

Answer 7

Acute MI, HF, valv disease

TX: dobutamine, dopamine, milrinone

Question 8

Dobutamine

Answer 8

Pro
-Inotrope + dilator
-Fast on/offset
-Less hypotension vs Mil

Con
-Increase HR
-Proarrhythmic
-BB interaction

BM HAH

Question 9

Milrinone

Answer 9

Pro
-Inotrope + VD
-Minimal HR effect
-DOC with BB

Con
-More hypotension
-Proarrhythmic
-Slower on/offset

HAD B

Question 10

Dopamine

Answer 10

Pro
-Inotrope + constrictor
-Good for hypotn

Con
-Increase HR, PCWP, O2 demand
-Proarrhythmic

HOP HAG

Question 11

Norepinephrine

Answer 11

1st line for septic shock (alpha agent potent)

Useful if hypotn

Decrease arrhythmias vs dopamine

Increase HR

Less B1 effects

FAHA = first, alpha, good for hypo, less arr

Question 12

Epinephrine

Answer 12

Pro
-Strong B1 agonist
-Help with hypotn

Con
-Increase HR
-Proarrhythmic

Typically for unresponsive patients in septic shock (add to norepinephrine)

Question 13

Vasopressin

Answer 13

Effective in acidosis

Not monotherapy

Used in septic shock

SAM

Question 14

Phenylephrine

Answer 14

Septic shock

-No tachycardia

Question 15

Angiotensin II

Answer 15

Increase BP in septic/distributive shock

Question 16

Extravasation

Answer 16

Phentolamine 5-10 mg in NS
-Max 10 mg

Terbutaline 1 mg/10 ml NS

NTG ointment