Shock

Question 1

Definition of Shock

Answer 1

Inadequate organ perfusion to meet the tissue’s oxygenation demand

Question 2

What qualifies as Hypotension

Answer 2

<60 or a decrease in 40 systolic

Question 3

Acidosis

Answer 3

From the accumulation of acid when anaerobic metabolism occurs.

Question 4

What happens during metabolic acidosis?

Answer 4

ATP production fails, the Na/K pump fails. Leads to cell swelling/rupture/death.

Question 5

Systemic vascular resistance index

Answer 5

(MAP-CVP)/CI all times 80

Question 6

Pulmonary vascular resistance index

Answer 6

MPAP - PAWP / ci * 80

Question 7

When does anaerobic metabolism occur?

Answer 7

If oxygen demand is greater than oxygen consumption.

Question 8

Signs of organ hypoperfusion

Answer 8

Mental status changes, oliguria, lactic acidosis

Question 9

4 Categories of shock

Answer 9

Cardiogenic, hypovolemic, obstructive, distributive

Question 10

Goals of shock resuscitation

Answer 10

Restore blood pressure, normalize perfusion, preserve organ function

Question 11

Hypovolemic shock

Answer 11

Occurs from low blood volume. From trauma/hemorrhage, diarrhea, dehydration, burns!

Question 12

Signs of hypovolemic shock

Answer 12

Decreased CO, decreased PAWP, increased SVR

Question 13

Treatment of hypovolemic shock?

Answer 13

Reverse hypovolemia with crystalloid/colloid. Control hemorrhage. Maybe give pressor agents.

Question 14

Crystalloid vs colloid

Answer 14

Crystalloids are cheaper. Blood must supplement either. No survival benefit with colloids.

Question 15

Cardiogenic shock

Answer 15

Defect in cardiac function

Question 16

Signs of cardiogenic shock

Answer 16

Decreased CO, increase PAOP, increase SVR, decrease LVSW

Question 17

Coronary perfusion pressure

Answer 17

= DBP -PAWP.

Question 18

What is the goal coronary perfusion pressure

Answer 18

> 50mmHg

Question 19

How to treat cardiogenic shock

Answer 19

Fluids first, cautious pressors. Give inotropes too.

Question 20

Distributive shock

Answer 20

Sepsis, anaphylaxis, acute adrenal insufficiency, neurogenic

Question 21

Signs of distributive shock

Answer 21

Generally decreased SVR. Not sure about CO or PAOP

Question 22

Systemic inflammatory response syndrome treatment

Answer 22

Prompt volume replacement, give antibiotic, give inotropes (Da first). If really low map, give DA and then NE

Question 23

Obstructive shock

Answer 23

Tamponade, tension pneumothorax, massive PE.

Question 24

Signs of obstructive shock.

Answer 24

Decreased Co, Increase PCOP, Increased SVR