Shock Articles Flashcards
The structure and function of the _____ layer which is a ____, are
key determinants of membrane permeability in various vascular organ systems.
endothelial glycocalyx layer….. web of
membrane-bound glycoproteins and proteoglycans on endothelial cells
The ______ produces a colloid oncotic
pressure that is an important determinant of
transcapillary flow.
subglycocalyx space
Fluid re-absorption does not occur though _____. Fluid from interstitial space is returned to circulation primarily though ____.
- capillaries…..lymph
Resuscitation fluids are broadly categorized
into _____ solutions
colloid and crystalloid
_____ are suspensions of molecules
within a carrier solution that are relatively incapable
of crossing the healthy semipermeable
capillary membrane owing to the ______.
Colloid solutions ….. molecular weight
of the molecules
_____ are solutions of
ions that are freely permeable but contain concentrations
of ______ that determine
the tonicity of the fluid.
Crystalloids…..sodium and chloride
_____are inexpensive and widely
available and have an established, although unproven,
role as first-line resuscitation fluids. However their use is associated with ______.
Crystalloids…..clinically
significant interstitial edema
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
albumin
The use of _____ solutions has
largely been superseded by the use of other semisynthetic
solutions.
dextran
Set backs in using albumin
- limited availability
- expensive
_____ is the most commonly
used crystalloid solution on a global basis, particularly
in the United States.
Sodium chloride (saline)
Concern about sodium and water overload
associated with saline resuscitation has resulted
in the concept of ____crystalloid
resuscitation with the use of _____solutions.
“small volume” …..hypertonic saline
3%, 5%, and 7.5%
Crystalloids with a chemical composition that
approximates extracellular fluid have been termed
______ are are _____
“balanced” or “physiologic” solutions…..hypotonic
(because they have a lower sodium concentration
than extracellular fluid)
Sepsis: _____ are the
most common gram-positive, whereas
______predominate among gram-negative.
Staphylococcus
aureus and Streptococcus pneumoniae …..Escherichia coli, klebsiella species, and Pseudomonas
aeruginosa
Acute organ dysfunction in sepsis affects ____
respiratory (ARDS) and CV systems (hypotension or elevated serum lactate)
Severe sepsis is almost invariably associated with
altered coagulation, frequently leading to _____
disseminated
intravascular coagulation
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 ____
6 hours….in the
ICU for support of organ function
The principles of the initial management
bundle are to provide _____
cardiorespiratory resuscitation
and mitigate the immediate threats of
uncontrolled infection
For shock that is persistent despite adequate circulating volume,
______ are recommended to maintain perfusion of vital
organs.
vasopressors
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.
- focused history and physical examination ….. focused ultrasonography
Four parts of a fluid challenge to determine the pts response to fluids:
- Select a fluid type.
- define fluid rate
- define your objective
- define safety limits
First choice vasopressor?
NE
Inotropic
agent of choice for increasing cardiac output, regardless
of whether norepinephrine is also being
given?
Dobutamine
Vasodilators increase CO without increasing myocardial O2 demand by?
reducing ventricular afterload
4 phases in the treatment of shock?
- Salvage
- Optimize
- stabilization
- De-escalation
Treatment of shock Phase 1: Salvage
achieve a minimum blood pressure and cardiac
output compatible with immediate survival
Treatment of shock Phase 2: Optimise
goal is to increase cellular oxygen availability, and
there is a narrow window of opportunity for interventions
targeting hemo dynamic status
Treatment of shock Phase 3: Stabilization
the goal is to prevent organ
dysfunction, even after hemodynamic stability has
been achieved; organ support
Treatment of shock Phase 4: de- escalation
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
