Shock Articles

Question 1

The structure and function of the _____ layer which is a ____, are
key determinants of membrane permeability in various vascular organ systems.

Answer 1

endothelial glycocalyx layer….. web of

membrane-bound glycoproteins and proteoglycans on endothelial cells

Question 2

The ______ produces a colloid oncotic
pressure that is an important determinant of
transcapillary flow.

Answer 2

subglycocalyx space

Question 3

Fluid re-absorption does not occur though _____. Fluid from interstitial space is returned to circulation primarily though ____.

Answer 3

• capillaries…..lymph

Question 4

Resuscitation fluids are broadly categorized

into _____ solutions

Answer 4

colloid and crystalloid

Question 5

_____ are suspensions of molecules
within a carrier solution that are relatively incapable
of crossing the healthy semipermeable
capillary membrane owing to the ______.

Answer 5

Colloid solutions ….. molecular weight

of the molecules

Question 6

_____ are solutions of
ions that are freely permeable but contain concentrations
of ______ that determine
the tonicity of the fluid.

Answer 6

Crystalloids…..sodium and chloride

Question 7

_____are inexpensive and widely
available and have an established, although unproven,
role as first-line resuscitation fluids. However their use is associated with ______.

Answer 7

Crystalloids…..clinically

significant interstitial edema

Question 8

Resuscitation with_____ was associated
with a decrease in the adjusted risk of death at
28 days in patients with severe sepsis, suggesting
a potential, but unsubstantiated, benefit in
patients with severe sepsis

Answer 8

albumin

Question 9

The use of _____ solutions has
largely been superseded by the use of other semisynthetic
solutions.

Answer 9

dextran

Question 10

Set backs in using albumin

Answer 10

• limited availability

- expensive

Question 11

_____ is the most commonly
used crystalloid solution on a global basis, particularly
in the United States.

Answer 11

Sodium chloride (saline)

Question 12

Concern about sodium and water overload
associated with saline resuscitation has resulted
in the concept of ____crystalloid
resuscitation with the use of _____solutions.

Answer 12

“small volume” …..hypertonic saline

3%, 5%, and 7.5%

Question 13

Crystalloids with a chemical composition that
approximates extracellular fluid have been termed
______ are are _____

Answer 13

“balanced” or “physiologic” solutions…..hypotonic
(because they have a lower sodium concentration
than extracellular fluid)

Question 14

Sepsis: _____ are the
most common gram-positive, whereas
______predominate among gram-negative.

Answer 14

Staphylococcus
aureus and Streptococcus pneumoniae …..Escherichia coli, klebsiella species, and Pseudomonas
aeruginosa

Question 15

Acute organ dysfunction in sepsis affects ____

Answer 15

respiratory (ARDS) and CV systems (hypotension or elevated serum lactate)

Question 16

Severe sepsis is almost invariably associated with

altered coagulation, frequently leading to _____

Answer 16

disseminated

intravascular coagulation

Question 17

The most important elements of the guidelines
are organized into two “bundles” of care: an initial
management bundle to be accomplished within
____ after the patient’s presentation and a
management bundle to be accomplished ____

Answer 17

6 hours….in the

ICU for support of organ function

Question 18

The principles of the initial management

bundle are to provide _____

Answer 18

cardiorespiratory resuscitation
and mitigate the immediate threats of
uncontrolled infection

Question 19

For shock that is persistent despite adequate circulating volume,
______ are recommended to maintain perfusion of vital
organs.

Answer 19

vasopressors

Question 20

A prompt diagnosis of septic
shock begins with a _____ for
signs and symptoms of infection and may require ____
to recognize complex physiologic manifestations of shock.

Answer 20

• focused history and physical examination ….. focused ultrasonography

Question 21

Four parts of a fluid challenge to determine the pts response to fluids:

Answer 21

1. Select a fluid type.
2. define fluid rate
3. define your objective
4. define safety limits

Question 22

First choice vasopressor?

Answer 22

NE

Question 23

Inotropic
agent of choice for increasing cardiac output, regardless
of whether norepinephrine is also being
given?

Answer 23

Dobutamine

Question 24

Vasodilators increase CO without increasing myocardial O2 demand by?

Answer 24

reducing ventricular afterload

Question 25

4 phases in the treatment of shock?

Answer 25

1. Salvage
2. Optimize
3. stabilization
4. De-escalation

Question 26

Treatment of shock Phase 1: Salvage

Answer 26

achieve a minimum blood pressure and cardiac

output compatible with immediate survival

Question 27

Treatment of shock Phase 2: Optimise

Answer 27

goal is to increase cellular oxygen availability, and
there is a narrow window of opportunity for interventions
targeting hemo dynamic status

Question 28

Treatment of shock Phase 3: Stabilization

Answer 28

the goal is to prevent organ
dysfunction, even after hemodynamic stability has
been achieved; organ support

Question 29

Treatment of shock Phase 4: de- escalation

Answer 29

the goal is to wean the patient
from vasoactive agents and promote spontaneous
polyuria or provoke fluid elimination through the
use of diuretics or ultrafiltration to achieve a negative
fluid balance