Shock

Question 1

Which type of shock would you suspect with the following values:
- CVP is decreased
- PAOP/PCWP increased
- CO/CI decreased
- SVR increased
- SvO2 decreased

Answer 1

cardiogenic shock
- heart not able to effectively pump blood out resulting in back up into the lungs and reduce output
- not a volume problem

Question 2

Which type of shock would you suspect with the following values:
- CVP is decreased
- PAOP/PCWP decreased
- CO/CI decreased
- SVR increased
- SvO2 decreased

Answer 2

hypovolemic shock
- reduce overall volume (loss or third spacing) causes decreased blood return to the heart

Question 3

What is the treatment for cardiogenic shock?

Answer 3

• treat underlying cause
• cardiac support
  
  • nitroglycerin dilates coronary arteries to increase cardiac perfusion
  • vasopressors to increase BP
  • inotropes to increase CO/CI
• support airway/O2

Question 4

Which is the only type of shock where the PAOP/PAWP will be increased?

Answer 4

cardiogenic shock

Question 5

What are causes of cardiogenic shock?

Answer 5

• Acute myocardial infarction
• acute heart failure
• arrhythmias
• cardiac tamponade

Question 6

Which type of shock would you suspect with the following values:
- CVP is increased
- PAOP/PCWP decreased
- CO/CI decreased
- SVR increased
- SvO2 decreased

Answer 6

obstructive shock
- blockage of blood to the ventricles or superior/inferior vena cava
- causes reduce cardiac filling

Question 7

What are causes of obstructive shock?

Answer 7

• acute pulmonary embolism
• tension pneumothorax
• cardiac tamponade

Question 8

What is the treatment for obstructive shock?

Answer 8

• treat underlying cause (remove obstruction)
• vasopressors
• fluid replacement, prevents hypotension post treatment
• airway/O2 support

Question 9

Which type of shock would you suspect with the following values:
- CVP is decreased
- PAOP/PCWP decreased
- CO/CI decreased
- SVR decreased
- SvO2 decreased

Answer 9

distributive shock
- septic shock (infection)
- neurogenic shock (spinal cord injury)
- anaphylactic shock (allergy)

Question 10

What is the treatment for anaphylactic shock?

Answer 10

• fluid replacement
• epinephrine
• glucocorticoids
• antihistamine
• consider H2 agonist and inhaled B2-agonist

Question 11

What is the treatment for neurogenic shock?

Answer 11

• fluid replacement
• alpha-agonist, causes vasoconstriction

Question 12

In what type of shock is the SVR decreased?

Answer 12

distributive shock
- septic shock
- neurogenic shock
- anaphylactic shock

Question 13

What are the 2 types of septic shock?

Answer 13

• hyperdynamic or warm septic shock
• hypodynamic or cold septic shock

Question 14

Why is the SvO2 increased in a patient with hyperdynamic or warm septic shock?

Answer 14

O2 delivery at the tissues is decreased or impaired resulting in an increased O2 return to the heart

Question 15

What is the treatment for septic shock (1 hr bundle)?

Answer 15

• measure lactate, redo at later time if >2 mmol/L
• blood cultures prior to ABX
• broad spectrum ABX
• fluid resuscitation with crystalloid at 30 mL/kg for hypotension or lactate > 4
• vasopressor and aline if still hypotensive after fluids
  
  • levo is 1st line
  • vasopressin if levo is not enough
  • dobutamine or epi if cardiac dysfunction is present and BP is adequate

Question 16

What is the 1st line vasopressor to use to treat septic shock?

Answer 16

Norepinephrine or levphed