Shock

Question 1

What is a good big picture definition of shock? What is the problem?

Answer 1

Hypo perfusion of the body so hypoxia of cells in organs

Question 2

What do we consider the systolic pressure in shock patient or the MAP?

Answer 2

Systolic is less than 80 or has dropped 40 below what it normally is. MAP is less than 60

Question 3

What usually accompanies shock and what is a reflection of tissue hypoxia?

Answer 3

Acidosis. Lactate levels.

Question 4

What is the difference of a patients skin/extremities in a vasodilation shock vs. a hypovolemic shock?

Answer 4

Warm and pink for a VD shock and cool/clammy/cyanotic dry for hypovolemic.

Question 5

What if the neck veins are distended, what kind of shock are we thinking of?

Answer 5

Heart failure type of deal

Question 6

What if we see the neck veins flat, what kind of shock we dealing with?

Answer 6

Hypovolemic

Question 7

What’s goin on with HR, BP and the kidneys during shock?

Answer 7

Usually fast HR, low BP, and oliguria

Question 8

What’s going on with heart and brain?

Answer 8

Heart is hurting because of ischemia. Because of the drop of cerebral perfusion, patient has mental status changes.

Question 9

What about metabolic changes because of shock?

Answer 9

Respiratory alkalosis first because rapid breathing, but then followed by metabolic acidosis and increase in lactate.

Question 10

What are the 4 types fo shock?

Answer 10

Hypovolemic, distributive, cardiogenic, extracardiac obstructive shock

Question 11

3 types of hypovolemic shock and which one is most common?

Answer 11

Hemorrhagic, non bleeding like a burn, or DKA. Bleeding is most common

Question 12

What is the blood loss amount in the 4 classes of hemorrhagic shock?

Answer 12

1. Up to 750
2. 750 to 1500
3. 1500-2000
4. Greater than 2000

Question 13

What class does BP start to decrease and is no longer considered normal? Also, which class do we start to give blood with fluid replacement?

Answer 13

3

Question 14

What exactly is distributive shock?

Answer 14

Vasodilation shock because of sepsis or non sepsis.

Question 15

4 criteria for sepsis?

Answer 15

Temp greater than 38 or lower than 36
HR over 90
RR over 20
WBC over 12k or under 4K

Question 16

Big picture patho of distributive shock?

Answer 16

Either the infection in sepsis or tissue hypoxia causes systemic inflammation which leads to increased permeability and massive VD by NO2.

Question 17

What could a chest x ray show if we are thinking sepsis?

Answer 17

Infiltration into a lobe.

Question 18

What 3 tests to order that would be helpful in determining sepsis?

Answer 18

Chest x ray, CBC, EKG to check tachycardia, and blood cultures for the culprit.

Question 19

Good antibiotic for sepsis? If patient doesn’t respond to fluid, what do we do next to get pressure up? Which specific drug. What two actions of dopamine help a shock patient?

Answer 19

Vancomycin. Vasopressin. Nor epi. HR and contractility.

Question 20

What 4 systems will have signs and symptoms for anaphylactic shock?

Answer 20

Cutaneous/skin, respiratory, stomach, and vascular.

Question 21

What is the patho of anaphylactic shock and what type of hypersensitivity is it?

Answer 21

Type 1 IGE. Mast cells release inflammatory mediators to cause VD, increased permeability, smooth muscle contraction, and inflammation.

Question 22

Good definition of cardiogenic shock?

Answer 22

We are not developing O2 to the body because of a problem with cardiac function.

Question 23

What are the three classifications of cardiogenic shock and give an example?

Answer 23

1. Cardiomyopathic - MI
2. Arrhythmogenic - dangerous arrhythmia. VT, VF, heart block
3. Mechanical - valve issue.

Question 24

4 clinical signs that help with the diagnosis of cardiogenic shock?

Answer 24

Drop in BP and urine O
Distended neck veins
Pulmonary edema
Mental status changes

Question 25

What is the most common cause of cardiogenic shock?

Answer 25

LV failure due to AMI

Question 26

2 other causes of cardiogenic shock worth mentioning?

Answer 26

Acute MR and VSD

Question 27

What is the big picture patho to cardiogenic shock?

Answer 27

Pump failure so you aren’t sending out enough blood to body or heart and then because you aren’t pumping it out of the heart, you are backing it up in the lungs and getting pulmonary congestion/edema.

Question 28

Talk about treatment for cardiogenic shock because of MI?

Answer 28

CABG if bad enough. Mechanical support with IABD, LVAD or ecmo if needed. Give pressers and inotropes like Norepinephrine, dopamine, dobutamine.

Question 29

What is a good definition of extra cardiac obstructive shock?

Answer 29

Acute obstruction somewhere blocking the flow of circulation.

Question 30

2 classifications of EOS?

Answer 30

1. Pulmonary vascular obstruction like a PE or severe pulmonary HTN.
2. Mechanical like tamponade

Question 31

Pleuritic chest pain plus dyspnea?

Answer 31

PE

Question 32

Chronic dyspnea, increased P2?

Answer 32

PHTN

Question 33

Chest pain, tracheal deviation, and decreased breath sounds on one side?

Answer 33

Tension pneumothorax

Question 34

Distended neck veins, muffled heart sounds, and dilated IVC?

Answer 34

Cardiac tamponade

Question 35

If there is an equalization of pressures in the heart and pulmonary, what are we thinking?

Answer 35

Tamponade

Question 36

What is the location of a emergent tube thoracostomy?

Answer 36

5th ICS MCL

Question 37

What is virchows triad?

Answer 37

Endothelial injury, stasis of blood/stress, and hyper coagulable

Question 38

What is the d dimmer result for PE?

Answer 38

If its negative, not likely a PE

Question 39

What is the ECG tracing for PE?

Answer 39

S1q3t3