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850 Exam #4 > Shock > Flashcards

Shock Flashcards

1
Q

Clinical end points used to Identify shock

A
  • SBP < 90mmHg
  • MAP < 65mmHg
  • Elevated lactate > 4mmol/l
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2
Q

Impaired O2 utilization

A
  • Anaerobic metabolism takes over

- Much less effective than aerobic metabolism

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3
Q

Shock is driven by what

A
  • Reduced cardiac output (CO)

- Reduced systemic vascular resistance (SVR)

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4
Q

Cardiogenic Shock Cause

A

-Problem with the pump

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5
Q

Cardiogenic Shock Treatment

A
  • Make it PUMP
  • Vasopressor
  • Inotrope
  • Diuresis (Cautious)
  • AVOID Beta blockers and calcium channel blockers (-inotropes)
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6
Q

Hypovolemic shock cause

A

-Hole in the bucket

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7
Q

Hypovolemic shock treatment

A
  • Stop bleeding/fluid loss
  • Fluids (LR, NS or D5W)
  • Vasopressors
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8
Q

Neurogenic shock cause

A

-Vasodilation with out compensatory tachycardia

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9
Q

Neurogenic shock treatment

A
  • Fluids
  • Vasopressors
  • Inotropes
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10
Q

Anaphylactic shock (distributive shock) Cause

A
  • Allergic

- Immune/ inflammatory response

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11
Q

Anaphylactic shock (Distributive shock) treatment

A
  • Steroids
  • Antihistamines
  • Fluids
  • Epinephrine
  • Antivenom if available
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12
Q

Septic shock (distributive shock) cause

A
  • Bacteremia
  • Endo/exotoxins
  • LPS gram negative
  • Gram positive bugs
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13
Q

Septic shock (distributive shock) treatment

A
  • remove/ suppress the infection
  • Fluids
  • Vasopressors
  • Abx
  • Source control
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14
Q

Sustained shock can lead to what

A

-Multi organ dysfunction syndrome (MODS)

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15
Q

Primary MODS

A
  • Damage to organ system directly related to a specific insult
  • Usually due to trauma or thermal injury
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16
Q

Secondary MODS

A
  • Exaggerated response of immune system to secondary insults

- Leading to further organ dysfunction and worsening outcomes

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17
Q

Common causes of hypovolemic shock

A
  • Bleeds
  • Burns
  • Trauma
18
Q

Cardiogenic shock presentation

A
  • Pulmonary edema
  • Hypotension
  • Weak pulse
  • Cool extremities
19
Q

Cardiogenic shock treatment for patients with STEMI

A
  • PCI or CABG
  • Fibrinolytic if PCI or CABG cannot be done
  • Aortic balloon pump
20
Q

Name the three different types of “Distributive” shock

A
  • Neurogenic
  • Anaphylactic
  • Septic
21
Q

New scoring system for Sepsis

A

Must have 2 of the following

  • RR > 22
  • Altered mental status
  • SBP < 100
22
Q

Hour 1 bundle for sepsis patients

A
  • Measure lactate levels
  • Blood cultures
  • Broad spectrum abx
  • Fluids (hypotension or > lactate)
  • Vasopressors (MAP < 65)
23
Q

Target of vasopressor therapy

A

-MAP > 65mmHg

24
Q

Examples of vasopressors

A
  • Norepinephrine
  • Vasopressin
  • Epinephrine
  • Phenylephrine
  • Dopamine
25
Q

Which vasopressor is first line

A

-Norepinephrine

26
Q

Drug class of dobutamine

A

-Inotropic agent

27
Q

When should abx be administered by

A

-With in the first hour of septic shock recognition

28
Q

When do we use IV hydrocortisone

A

-Patients with hemodynamic instability despite fluid and vasopressor therapy

29
Q

When do you initiate insulin therapy

A

-two blood glucose measurements > 180mg/dL

30
Q

Who gets DVT prophylaxis?

A
  • Everyone
  • LMWH or UFH
  • Enoxaparin is preferred
31
Q

Induction medications for intubation

A
  • Etomidate
  • Ketamine
  • Midazolam
  • Propofol
32
Q

Paralytic medications

A
  • Succinylcholine
  • Rocuronium
  • Vecuronium
33
Q

General approach to treatment of pain

A
  • Should be individualized
  • Use minimum effective dose
  • Administer preemptively
34
Q

What drug class is first line for non-neurologic pain

A
  • IV opioids

ex. fentanyl, morphine, hydromorphone

35
Q

Daily sedation interruption purpose

A
  • Allows for assessment of neurologic function

- May prevent drug accumulation and overdose

36
Q

What are the monitoring parameters for daily sedation interruption

A

3/4 of the following

  • Open eyes
  • Maintain eye contact
  • Squeeze hand, stick out tongue
  • Wiggle toes
37
Q

Benzos or non-benzos?

A

-Non benzos are preferred over benzos

38
Q

List two benzos commonly used

A
  • Midazolam

- Lorazepam

39
Q

List two non benzos commonly used

A
  • Propofol

- Precedex

40
Q

Where does propylene glycol toxicity come from?

A

-Diluent in parenteral lorazepam formulations

850 Exam #4 (5 decks)

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