Shock

Question 1

Hypovolemic shock occurs when

Answer 1

decrease in circulating volume and oxygen-carrying capacity

Question 2

How to diagnose Hypovolemich shock (arrows

Answer 2

CVP- decreased
PCWP- decreased
CO- decreased
SVR- increased

Question 3

Etiologies of hypovolemic shock

Answer 3

Hemorrhage
Dehydration
Gastrointestinal
Urinary losses

Loss of more than 15 to 30% of normal blood volume.

Question 4

Treatment of hypovolemic shock

Answer 4

IV fluid resuscitation- IV Crystalloids, PRBCs/blood products (hemorrhagic hypovolemic shock),

Pressors (Norepinephrine, first line in most shock states)

Question 4

Cardiogenic occurs due to

Answer 4

L ventricular systolic failure and Results from the heart’s inability to adequately circulate blood to the tissues

Question 5

How to diagnose cariogenic shock (arrows)

Answer 5

CVP- increased
PCWP- increased
CO- decreased
SVR- increased

SBP<90 for >30 mins, + pressors, urine output <30ml/hr, CI <2.2, PCWP >15mmHg and lactic acid >2

Question 6

Etiologies of cardiogenic shock

Answer 6

Damage to the myocardium as myocardial infarction or cardiomyopathy
Structural defects to the cardiac values or septum
Arrhythmias
acute MR

Question 7

Treatment of cariogenic shock

Answer 7

CI and CABG remains the only treatment modality with proven benefits

Medical management with inotropes :Dobutamine, dopamine, norepi and epi

Question 8

what 2 pressers are not recommended for cardiogenic shock

Answer 8

Phenylephrine & vasopressin

Question 9

Distributive shock is characterized by

Answer 9

vasodilation and redistribution of blood volume

Question 10

diagnosis of distributive shock

Answer 10

CVP: decreased
PCWP: decreased
CO: increased
SVR: decreased

Question 11

Etiologies of distributive shock are:

Answer 11

Sepsis- dx by SOFA score
Spinal cord injury
Anaphylaxis
Vasodilatory shock resulting from mast activation of histamine

Question 12

treatment of sepsis

Answer 12

aggressive fluid resus, 30mL/kg IBW IV balanced, pressors, ABX, source control, normalize lactate

Question 13

Spinal cord injury (Neurogenic shock)

Answer 13

Norepinephrine preferred possibly d/t lower intrathecal pressure and high spinal cord perfusion pressure

Phenylephrine ok but beware of reflex bradycardia

Question 14

Anaphylaxis treatment

Answer 14

Stop the inflammatory response
Epinephrine IM 0.3-0.5 mg (severe cases may go IV)
H1 blockers (Benadryl)
H2 blockers (Pepcid,zantac)
If on beta blocker- glucagon

Question 15

Obstructive shock results from

Answer 15

Result of impairment in cardiac ventricular filling or ventricular emptying

Question 16

Diagnosis of obstructive shock :

Answer 16

CVP: increased CVP
PCWP- increased/decreased
CO- decreased
SVR-increased

Question 17

Etiologies of Obstructive Shock:

Answer 17

Cardiac tamponade
Tension pneumothorax
PE

Question 18

Treatment of shock:

Answer 18

Goal is to remove the obstruction as quickly as possible
Cardiac tamponade
Pericardiocentesis to remove accumulated fluid around the heart

Tension pneumothorax
needle decompression or Chest tube for lung reexpansion

PE
Administer thrombolytic