Shock

Question 1

What is SIRS?

Answer 1

Wide spread inflammatory response from a multitude of pathological causes

Question 2

What is MODS?

Answer 2

Altered organ function in the acutely I’ll where homeostasis cannot be maintained

Question 3

Initial shock is what?

Answer 3

The first stage of shock. There is no indication of hypo perfusion yet

Question 4

The second shock stage, compensatory shock is what?

Answer 4

The neuroendocrine system is attempting to compensate to restore perfusion. (Barorrceptor reflex, SNS stimulation; CNS response, hormonal response)

Question 5

What is the progressive stage of shock?

Answer 5

The inability of the neuroendocrine system to maintain tissue perfusion. Tissue perfusion decreased is now evident

Question 6

Refractory shock is what?

Answer 6

Irreversible stage, unresponsive to vasopressors

Question 7

What are some causes of hypovolemix shock?

Answer 7

Bleed
DKA/HHS
Addisons
NGT suction
DI
Diuretic 
Burns
Heat exhaustion

3rd spacing- intestinal obstruction, cirrhosis, pancreatitis, hypoprotenemia

Question 8

At what percentage of blood loss will you begin to see low BP and PP?

Answer 8

15% or greater

Question 9

What ratio do you replace crystaloids on a blood loss patient?

Answer 9

3:1 ratio

NS
LR
Plasmalyte

Question 10

Blood product replaces blood at war ratio?

Answer 10

1:1

PRBC
FFP
Hextend

Question 11

If someone looses 15% of blood or less, how much do you give them back?

Answer 11

1L crystaloids the. Maitanence

Question 12

If someone loses 15-30% blood how do you replace them?

Answer 12

2L crystaloids then reevaluate

Question 13

If someone loses 30-40% or more blood how do you replace it?

Answer 13

2L crystaloids reevaluate, replace blood product at 1:1 ratio and maintain urine at>0.5mL/kg/HR

Question 14

What is the S1Q3T3 on an EKG? What does it tell you?

Answer 14

S wave in lead 1
Q wave in Lead 3
T inversion in lead 3

Could indicate a PE, PNX, tamponade

Question 15

What options for treatment do you have for obstructive shock?

Answer 15

Anticoagulation
Thrombocytes
Embolectomy
Filter placement

Question 16

How to you treat cardiogenic shock with ischemia?

Answer 16

Inotropes, Revascularization, afterload reduction: Meds vs VAD or IABP

Question 17

How do you treat aortic dissection with AI?

Answer 17

Surgery, afterload reduction

Question 18

How do you treat neurogenic shock?

Answer 18

Atropine
Dopamine
Fluids
Pacing

Question 19

How do you treat anaphulylactic shock?

Answer 19

Elevate lower extremities
Evaluate airway
Fluids
Epi 1:1000 0.2-0.5 SQ (can repeat 2-3 times at 10-15 minute interval)
Epi gtt
H1 (benedryl)
H2 ranitidine 
Steroids

Question 20

What are some general criteria for Sepsis?

Answer 20

Increased or decreased temp 
Increased RR
AMS
Edema
Increased blood sugar

Question 21

What are some inflammatory criteria for Sepsis?

Answer 21

Leukocytosis or leukopenia
Plasma C reactive protein
Procalcitonin

Question 22

A P/F ratio of what indicates ALI? What about ARDS?

Answer 22

ALI is P/F ratio of < 300

Question 23

What do you want to CVP at in sepsis?

Answer 23

8-12

Question 24

What is a goal MAP in sepsis?

Answer 24

> 65

Question 25

What is the goal Urine output in sepsis?

Answer 25

> 0.5ml/kg/hr

Question 26

What is the goal ScVO2 or SVO2 (mixed venous oxygen) in sepsis?

Answer 26

ScVO2- 70%

SVO2- 65%

Question 27

How quickly should ABX be started in sepsis?

Answer 27

Within the first hour for a duration of 7-10 days

Question 28

I’d during a fluid challenge in sepsis a patient becomes metabolic acidosis what do you do?

Answer 28

Can give bicarbonate gtt if pH

Question 29

What is the first line pressor for sepsis?

Answer 29

Levo, then Vaso, then Epi

Question 30

If patient is in refractory shock what other medication can you give if patient is pressor dependant?

Answer 30

Steroids

Hydrocortisone up to 200mg/day