Shock

Question 1

Define: Shock

Answer 1

Inadequate tissue perfusion –> decreased O2 delivery –> hypoxia & metabolic malfxn
- Compensatory mechanisms are overwhelmed

Question 2

What can shock result in?

Answer 2

• Cell death
• End organ damage
• Death

Question 3

What is the equation for systemic tissue perfusion?

Answer 3

MAP = CO x SVR

Question 4

What is SVR influenced by?

Answer 4

• Vessel length & diameter

- Blood viscosity

Question 5

What determines etiology of shock?

Answer 5

CO & SVR

Question 6

What are the 3 stages of shock?

Answer 6

• Pre-shock
• Shock
• End-organ damage

Question 7

Describe pre-shock (including S/S)

Answer 7

• Warm or compensated shock

- Tachy, peripheral vasoconstriction, decreased BP

Question 8

What are S/S of shock?

Answer 8

S/S of organ dysfunction appear

• Tachy
• Dyspnea
• Metabolic acidosis
• Oliguria
• Confusion
• Cool, clammy skin

Question 9

Describe end-organ dysfxn

Answer 9

• Progressive

- Irreversible organ damage, coma, death

Question 10

What are the 5 categories of shock?

Answer 10

• Distributive
• Hypovolemic
• Cardiogenic
• Neurogenic
• Obstructive

Question 11

What types of lines can you use for resuscitation?

Answer 11

• Arterial
• Central
• Swan-Ganz catheter

Question 12

Where can you place an arterial line?

Answer 12

• Radial a.
• Brachial a.
• Femoral a.

Question 13

Describe the fxn of an arterial line

Answer 13

Monitor arterial BP

*NOT used for administering meds

Question 14

Describe the fxn of a central line

Answer 14

• Deliver caustic/critical meds

- Measure CVP

Question 15

Define: CVP

Answer 15

Central venous pressure

- Pressure near RA

Question 16

What does CVP correlate to?

Answer 16

Preload or overall volume status

Question 17

What is a normal CVP value?

Answer 17

5-15

Question 18

Define: PCWP

Answer 18

Pulmonary capillary wedge pressure

- LA pressure

Question 19

What is a normal PCWP value?

Answer 19

5-15

Question 20

PCWP over 20mmHg indicates…

Answer 20

fluid overload

Question 21

What is a normal CO value?

Answer 21

4-8

Question 22

What is a normal SVR?

Answer 22

1000-1500

Question 23

What type of line is most appropriate in cardiogenic shock?

Answer 23

Swan-Ganz catheter

Question 24

What is the classic presentation of shock? What are the exceptions?

Answer 24

• Hypotension (SBP <90, or acute decrease in SBP of > 40)
• Tachy (*Exception: Neurogenic shock = decreased HR)
• Oliguria
• Mental status changes
• Cool clammy skin (*Exception: early distributive & neurogenic = flushed, warm)
• Multi-organ failure, coagulopathy

Question 25

When does lactate increase?

Answer 25

During anaerobic metabolism, derangements affecting O2 utilization & decreased hepatic clearance

Question 26

What is lactate associated w/?

Answer 26

Increased mortality

Question 27

In early septic shock, what is the initial response?

Answer 27

Vasodilation (to meet increased demand for O2)

Question 28

What does vasodilation lead to?

Answer 28

Hypotension

Question 29

Early septic shock is associated w/…

Answer 29

Hyperdynamic response

- Well compensated, but difficult to maintain

Question 30

In early septic shock, what do the endotoxins do?

Answer 30

Aggravate cellular hypoxia & exert toxic effects on soft tissues/organs

Question 31

What do you start to see in late septic shock?

Answer 31

Capillary leakage & loss of vascular tone –> relative hypovolemia & hypotension

Question 32

Hypovolemia & hypotension further stimulate the…

Answer 32

SNS –> increased HR & SVR