Shock Flashcards
What is the qSOFA score?
Screen + for 2/3 components:
1) RR > or = 22/min
(2) SBP < or = 100 mmHg
(3) Altered Mentation (GCS < 15
What is a normal central venous gas?
60-65%
What is a normal mixed venous gas?
65-70%
How much fluid should be given to a hypotension engine patient within the first4 hours?
30 ml/kg crystallized for hypotension or lactate > 4 mmol/L, given within the first 4 hours
In which situation would you use normal saline over Ringer’s lactate (3)?
(1) Refractory Hyperkalemia
(2) TBI Patients
(3) Hx of Mitochondrial Disease
What’s really the issue of giving more fluids in a patient who is fluid replete?
If fluid replete, more volume increases risk of:
(1) AKI
(2) ARDS
(3) Intra-abdominal compartment syndrome
What is the definition of fluid responsiveness?
Fluid responsiveness is defined as an:
(1) Increase in Stroke Volume (SV) OR
(2) Cardiac Output (CO)
Of at least 10-15% after a 250-500 cc fluid bolus.
How can the IVC variation-distensibility be used to assess fluid responsiveness?
In an intubated, fully ventilated patient, a distensibility index of > 15-20% suggests a patient is likely fluid responsive.
This technique is NOT validated in patients who are intubated and spontaneously breathing.
If a patient is NOT intubated, distensibility index > 40% likely fluid responsive.
What is the dosing range of norepinephrine?
Norepinephrine 0.03 to 0.35 mcg/kg/min
What are the different affects of dopamine as the dose increases?
(1) 1-2 mcg/kg/min - Primarily acts on dopamine-1 receptors in the renal, mesenteric and cerebral coronary beds, resulting in selective vasodilation.
(2) 5-10 mcg/kg/min - Stimulate beta-1 adrenergic receptors and increased CO, predominantly by increased stroke volume.
(3) > 10 mcg/kg/min - Alpha-adrenergic stimulation that increases SVR
- Dose limiting dysrhythmia at > 2 mcg/kg/min*
Explain the function of the various alpha and beta adrenergic receptors.
Alpha 1 - Increases SVR
Alpha 2 - Decreases SVR
Beta 1 - Increases chronotropy (HR), domotrophy (conduction) and INO trophy (contractility).
Beta 2 - Bronchodilation, relaxes smooth muscle, gall bladder and uterus.
How does isoproterenol work?
Acts on B-1 adrengergic receptors to increase HR & CO, but also has a high affinity for beta 2 receptors, which causes vasodilation and decreased MAP.
Use limited to situations where hypotension is due to bradycardia.
How does dobutamine work?
Largely beta-1 adrenergic effects, with minimal beta-2, therefore it increases inotropy, chronotropy and reduces LV filling pressure.
Net effect is increased CO with decreased SVR (possible small reduction in BP).
Used in severe, medically refractory cardiogenic shock.
How does milrinone work?
It is a phosphodiesterase inhibitor with inotropic and vasodilatory effects, though use can be limited by hypotension.
What are the negative associations of high dose vasopressin?
Doses of vasopressin over 0.03U/min have been associated with coronary and mesenteric ischemia, as well as skin necrosis.
