Shock

Question 1

Target Central Venous Pressure

Answer 1

8-12 mmHg, 12-15 mmHg intubated patients

Question 2

Fluid Resuscitation

Answer 2

Initial: crystalloid (NS or LR); challenge min of 30 mg/kg w/in first 3 h; albumin add’n

Question 3

Albumin in Resuscitation

Answer 3

Pt requires substantial amount of crystalloid, pt develops incr abdominal pressure or pulmonary edema

Question 4

Hydroxyethyl Starches

Answer 4

Avoid in fluid resuscitation

Question 5

Target of Resuscitation

Answer 5

MAP of at least 65 mmHg, UO of at least 0.5 L/kg/h, normal lactate

Question 6

Vasopressors

Answer 6

Central line preferred, Norepinephrine (1st choice), epinephrine (add’n to or sub for norEpi), vasopressin (add to norEpi before Epi), Dopamine (highly select pts), Phenylephrine (not rec)

Question 7

Norepinephrine

Answer 7

Initial 0.05 mcg/kg/min or 4 mcg/min; Max approx: 3 mcg/kg/min or 125 mcg/min

Question 8

Epinephrine

Answer 8

Initial: 0.05 mcg/kg/min; Range: 2-10 mcg/min

Question 9

Vasopressin

Answer 9

Indication: refractory septic shock, 1st line: malignant tachy or active coronary ischemia, dose: 0.01-0.04 units/min

Question 10

Dopamine

Answer 10

Indication: pt w/ low risk of tachy; dose: 2.5-20 mcg/kg/min

Question 11

Phenylephrine

Answer 11

Indication: NorEpi-assoc arrhythmias, high CO states, salvage tx; Dose: 100 mcg bolus or 50 mcg/min, Max: 400 mcg/min

Question 12

Inotropes

Answer 12

Potentially useful in resuscitated pt w/ persistent evidence of systemic or organ hypoperfusion; Dobutamine and Milrinone

Question 13

Dobutamine

Answer 13

Dose: 2.5-10 mcg/kg/min up to 20 mcg/kg/min; may cause hypotension and tachy

Question 14

Milrinone

Answer 14

Dose: 0.2-0.75 mcg/kg/min (lower in renal pts), LD: 50 mcg/kg over 10 min may be used; monotx or combo with dobutamine

Question 15

Corticosteroid Stress Dose

Answer 15

After fluids and vasopressors, hydrocortisone 50 mg iv q6h or 100 mg VI q8h for 7d

Question 16

Glycemic Control

Answer 16

Maintain BG 110-150 mg/dL