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Nelson - Emergencies > Shock > Flashcards

Shock Flashcards

1
Q

T/F The brain lacks the capacity for anaerobic metabolism

A

T

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2
Q

Criteria for cardiovascular dysfunction (MODS)

A

1) Despite administration of 60cc/kg isotonic fluid IV, decrease in BP <5th percentile for age or SBP <1 SD below normal for age 2) Need for vasoactive drug to maintain BP in normal range OR 2 of the ff: BE >5, lactate >2x upper limit of normal, UO <0.5cc/kg/hr, CRT >5, core to peripheral temp gap >3C

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3
Q

Criteria for respiratory dysfunction (MODS)

A

PaO2/FiO2 ratio <300 in the absence of CHD or pre-existing lung disease OR PaCO2 >20 over baseline OR proven need for >50% FiO2 to maintain O2sat ≥92% OR need for invasive or noninvasive mechanical ventilation

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4
Q

Criteria for neurologic dysfunction (MODS)

A

GCS ≤11 OR acute change in mental status with a decrease in GCS ≥3 points from baseline

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5
Q

Criteria for renal dysfunction (MODS)

A

Crea ≥2x upper limit of normal for age OR 2x increase in baseline value

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6
Q

Criteria for hepatic dysfunction (MODS)

A

TB ≥4mg/dL, ALT 2x upper limit of normal for age

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7
Q

Underlying pathophysiologic mechanism leading to distributive shock

A

State of abnormal vasodilation

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8
Q

Definition of pediatric sepsis

A

1) Suspected or proven infection or a clinical syndrome associated with high probability of infection 2) SIRS

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9
Q

Definition of severe sepsis

A

Sepsis + organ dysfunction

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10
Q

Definition of septic shock

A

Sepsis + cardiovascular organ dysfunction

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11
Q

SIRS criteria

A

2 of 4, 1 of which must be abnormal temp or abnormal WBC count: 1) Core temp >38.5 or <36 2) Tachycardia or persistent bradycardia over 0.5hr in children <1 y/o 3) RR >2SD above normal for age or acute need for mechanical ventilation not related to neuromuscular disease or general anesth 4) Elevated or depressed WBC for age not secondary to chemo OR >10% immature neutrophils

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12
Q

Tachycardia in definition of SIRS is qualified as

A

Mean HR ≥2SD above normal for age in absence of external stimuli, chronic drugs, or painful stimuli OR unexplained persistent elevation over 0.5-4 hours

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13
Q

Goals in fluid resuscitation for shock

A

Normal HR, UO 1cc/kg/hr, CRT <2, improved mental status

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14
Q

Smaller boluses of ___ should be given for cardiogenic shock

A

5-10cc/kg

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15
Q

Improves systolic function and decreases SVR without causing a significant increase in HR with added benefit of enhancing diastolic relaxation in cases of cardiogenic shock

A

Milrinone

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16
Q

Inotropes: Vasoconstrictor at high dose, vasodilator at low dose

A

Dopamine and Epinephrine

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17
Q

Inotropes: Potent inotrope, chronotrope, and direct pressor

A

Epi and Norepi

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18
Q

T/F Milrinone has no pressor nor chronotrope activity

A

T

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19
Q

T/F Dobutamine has no pressor activity

A

T

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20
Q

Type of Shock: DM/DI

A

Hypovolemic

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21
Q

Type of Shock: Androgenital syndrome

A

Hypovolemic

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22
Q

Type of Shock: CNS/Spinal injury

A

Distributive

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23
Q

Type of Shock: Drug intoxication

A

Distributive, cardiogenic

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24
Q

Type of Shock: Kawasaki

A

Cardiogenic

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25
Q

Type of Shock: Cardiac tumor

A

Obstructive

26
Q

Type of Shock: CO poisoning

A

Dissociative

27
Q

Type of Shock: Methemoglobinemia

A

Dissociative

28
Q

Breathing pattern: Diseases of decreased lung compliance

A

Rapid and shallow (decreased tidal volume)

29
Q

Breathing pattern: Obstructive airway diseases

A

Deep but less rapid (increased tidal volume)

30
Q

Extrathoracic vs intrathoracic airway obstruction: Inspiratory stridor

A

Extra

31
Q

Extrathoracic vs intrathoracic airway obstruction: Chest wall and subcostal retractions

A

Extra

32
Q

Extrathoracic vs intrathoracic airway obstruction: Prolongation of expiration

A

Intra

33
Q

Extrathoracic vs intrathoracic airway obstruction: Expiratory wheeze

A

Intra

34
Q

Extrathoracic vs intrathoracic airway obstruction: Prolongation of inspiration

A

Extra

35
Q

T/F Patient’s general state, respiratory effort, and potential for impending exhaustion are more important indicators for respiratory failure than blood gas values

A

T

36
Q

Consensus definition of Acute Lung Injury (ALI)

A

1) Acute onset (<7 days) 2) Severe hypoxemia (PaO2/FiO2 <300 for ALI, <200 for ARDS) 3) Diffuse bilateral pulmonary infiltrates on frontal radiograph consistent with pulmonary edema 4) Absence of left atrial htn

37
Q

T/F Both ventilation and perfusion are lower in nondependent areas of the lung and higher in dependent areas of the lung

A

T

38
Q

Venous admixture or incomplete arterialization of systemic venous (pulmonary arterial) blood results from

A

Perfusion in excess of ventilation

39
Q

Intrapulmonary shunting of systemic venous blood to systemic arterial circulation results from

A

Perfusion of unventilated areas of the lungs

40
Q

Diffusion defects manifests as hypoxemia vs hypercarbia

A

Hypoxemia (diffusion capacity of CO@ is 20x greater than that of O2)

41
Q

Formula for an estimation of the FiO2 during use of nasal cannula in older children and adults

A

FiO2 - 21% (LPM x 2)

42
Q

FiO2 values of a simple mask

A

0.30-0.65

43
Q

T/F A high flow nasal cannula provides significant CPAP

A

T

44
Q

Provide PAP during exhalation and additional positive pressure during inspiration

A

BiPAP

45
Q

Formula for ID or internal diameter of ET tube

A

Age/4+4

46
Q

Pressure necessary to move a given amount of air into the lung is determined by 2 factors

A

1) Lung and chest wall elastance 2) Airway resistance

47
Q

2 ventilator strategies commonly employed to improve O2 in diseases with decreased FRC

A

Application of PEEP and increasing iT

48
Q

What is recruitment

A

Process of opening atelectatic alveoli

49
Q

Mechvent mode: Inspiration is initiated at a set frequency with a timing mechanism independent of patient effort

A

SIMV

50
Q

Mechvent mode: Each and every patient breath is triggered by pressure of flow generated by patient inspiratory effort and assisted with either preselected inspiratory pressure or volume

A

AC

51
Q

Mechvent mode: Machine-delivered volume is the primary control and inflation pressure generated depends on respiratory system’s compliance and resistance

A

Volume-controlled ventilation

52
Q

Mechvent mode: Pressure change above baseline is primary control, and the TV delivered to the lungs depends on respiratory system’s compliance and resistance

A

Pressure-controlled ventilation

53
Q

Most useful expiratory maneuver in mechanical ventilation

A

Application of PEEP

54
Q

Most important clinical benefits of PEEP

A

Recruitment of alveoli AND increasing FRC

55
Q

iTime is usually initiated at ___ for neonates, ___ for older children, and ___ for adolescents and adults

A

0.5-0.7 sec, 0.8-1, 1-1.2

56
Q

In patients with severe acute hypoxemic respiratory failure, avoidance of TV ___ limits diffuse alveolar damage

A

≥10cc/kg

57
Q

Most effective strategy to minimize ventilator associated pneumonia

A

Regular assessment of extubation readiness and liberation from mech vent as soon as clinically possible

58
Q

Most objective means of assessing extubation readiness

A

Spontaneous breathing trial (SBT): CPAP with minimal or no pressure support with no episodes of respiratory or cardiovascular decompensation

59
Q

Populations at increased risk for extubation failure

A

1) Young infants 2) Mechanically ventilated >7 days 3) Chronic respiratory or neurologic conditions

60
Q

MCC of extubation failure in children

A

Post extubation upper airway obstruction

61
Q

Minimizes incidence of postextubation airway obstruction

A

IV corticosteroids, e.g. Dexa 0.5mg/kg q6 for 4 doses prior to extubation

Nelson - Emergencies (6 decks)

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