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CRITICAL CARE > SHOCK CRITICAL CARE > Flashcards

SHOCK CRITICAL CARE Flashcards

1
Q

arterial O2 equal

A

CaO2

1.39 times hemoglobin saturation 02+ (PaO2 x0.0031)

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2
Q

Central venous pressure measured where/normal value

A

right ventricular end-diastolic pressure

5-10

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3
Q

left atrial pressure measured where/ normal value; What adversely affects the

A

left ventricular end-diastolic pressure
5-15
mitral valve disease

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4
Q

pulmonary capillary wedge pressure measured where, normal value, what effect IT

A

rough equal left atrial pressure
5-15
height PEEP/pulmonary disease/mitral valve stenosis

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5
Q

mean arterial pressure calculation

A

map equals diastolic pressure +1/3 (systolic pressure minus diastolic pressure)
80-90

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6
Q

cardiac index

A

cardiac output divided by meter squared

2.5-3.5

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7
Q

systemic vascular resistance

A

SVR = (MAP - CVP) x 80/CO

1000-1500 dyne

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8
Q

pulmonary resistance

A

100-400 dyne

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9
Q

mixed venous oxygen content

A

CVO2
75%
15 cc O2 in 100 cc

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10
Q

O2 delivery

A

cardiac output times arterial arch and content x10

900-1200

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11
Q

02 consumption

A

250 mL/min

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12
Q

clinical determinant of preload

A

venous return (central venous pressure)

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13
Q

clinical determine of afterload

A

systemic resistance

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14
Q

general equation of her cardiac output

A

systemic resistance x heart rate

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15
Q

lift things that cause improvement of Frank Starling curve with ventricular dysfunction

A 
#1 diuretics
#2 inotrope
#3 vasodilator
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16
Q

how does dopamine compared to norepinephrine

A

dopamine and baby nor epinephrine

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17
Q

trade name for norepinephrine

A

levophed

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18
Q

class I hemorrhagic shock

A

10% blood volume

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19
Q

Class II hemorrhagic shock

A

20% blood volume
over 1000 mL
NARROW PULSE PRESSURE
TACHYCARDIA

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20
Q

Class III hemorrhagic shock

A

30% blood volume

HYPOTENSION

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21
Q

Class IV hemorrhagic shock

A

40% blood volume

DECREASED MENTATION

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22
Q

Immediate treatment for myocardial infarction

A 
Morphine
Oxygen
Aspirin/ACE inhibitor
 nitroglycerin
Angioplasty
23
Q

The reduce preload for cardiogenic shock

A 
Nitroglycerin
Calcium channel blocker
Narcotic
Diuretic
Venous dilatation
24
Q

Reduce afterload cardiogenic shock

A

Nitroprusside
Antihypertensive
Diuretic
Necrotic

25
Q

Gen. mechanism dopamine: Heart rate, contractility, preload, afterload

A

heart rate increased
contractility Increased
preload decreased
Increase/normal

26
Q

Gen. mechanism dobutamine:Heart rate, contractility, preload, afterload

A

Heart rate INCREASE
Contractility INCREASE the
Preload decrease
Normal decrease

27
Q

general mechanism isoproterenol Heart rate, contractility, preload, afterload

A

heart rate INCREASE
Contractility INCREASE
Preload decrease
After the decrease

28
Q

Gen. mechanism nitroprusside andHeart rate, contractility, preload, afterload

A

heart rate no change
Contractility no change
Preload decrease
Afterload DECREASE

29
Q

Gen. mechanism nitroglycerin Heart rate, contractility, preload, afterload

A

heart rate no change
Contractility no change
Preload DECREASE
Afterload decrease

30
Q

Intracellular changes with shock

A

increased intracellular sodium

Increase interest calcium

31
Q

how is pediatric Parkland formula modified

A

Parkland PLUS maintenance
Kidney D5 and a little K.
(approximately 15% above Parkland)

32
Q

rough oxygen saturation curve

A 
PaO2 40
Saturation 70
 PaO2 50
Saturation 80
PaO2 60
Saturation 90
40/50 60/70 80/90
33
Q

initiating event of shock

A

cellular energy deficit

Does not equal hypoxia

34
Q

factors at initiate afferent impulse to CNS neuroendocrine responsive shock

A 
#1 bottle circulating blood volume
#2 hypoxemia
#3 hypercarbia
#4 acidosis
#5 infection
 #6 temperature fluctuation
#7 emotional arousal
#8 hypoglycemia
35
Q

what arterial receptors give initial physiologic response to hypovolemic shock on arteriols

A

ACTIVATION of her adrenergic receptors arterials

36
Q

Primary affective ADH

A

Pituitary origin
“vasopressin”
Released from barrel receptors left atrial stretch
Stimulated by:
Epinephrine
Angiotensin II
Pain
Hyperglycemia
Acts on distal tibial and collecting duct INCREASES water permeability-decrease his water and sodium losses
Mesenteric vasoconstriction the
Increases hepatic gluconeogenesis last glycol cyst

37
Q

for cytokine signal released after major injury

A

tumor necrosis factor alpha

38
Q

Anti-inflammatory cytokine

A

interleukin-10

39
Q

weather hemodynamic changes seen with neurogenic shock

A

Increased cardiac index

Unchanged venous capacitance

40
Q

Percentage of blood line and splanchnic circulation

A

20%

41
Q

indirect estimate of oxygen debt withbasic labs value

A

base deficit

42
Q

Class I hemorrhagic shock

A

Less than15% blood volume

700 mL

43
Q

Class II hemorrhagic shock

A 
15-30% blood volume
750-1500 cc
Widened pulse pressure
Tachycardia
 orthostatic
Tachycardia
44
Q

Class III hemorrhagic shock

A

30-40%
1500-2000 cc
HYPOTENSION
Tachycardia to the 120s

45
Q

Class IV hemorrhagic shock

A

Greater than 40%
Greater than2,000 cc
Tachycardia 140s
OBTUNDED

46
Q

Trauma definition of systolic hypotension

A

110

47
Q

Classify severity of base deficit

A

Mild: -3 to -5
Moderate: -6 to -9
Severe: Greater than -10

48
Q

Mortality and percentage the patient with a base deficit of -6

A

25% and trauma related

49
Q

And INR 1.5 on arrival to ICU as what percent mortality

A

30%

Transfuse FFP

50
Q

What type of shock is seen with carbon monoxide poisoning

A

Vasodilatory shock

51
Q

This common causes of vasodilatory shock

A 
MOST common SEPTIC
Pancreatitis
Burns
Anaphylaxis
Acute adrenal insufficiency
Hypotension: Hemorrhagic, cardiogenic, cardiopulmonary bypass
Lactic acidosis
Carbon monoxide
52
Q

resistant cardiogenic shock medications are wet and have what potential side effects

A 
Phosphodiesterase inhibitors:
Amrinone
Milrinone
Thrombocytopenia
Hypotension
Reserve for unresponsive
53
Q

Acute MI post 12 hours in cardiogenic shock best treatment

A

Angiogram stent

Do not way to stabilize patient on inotropic support

54
Q

Classic neurogenic shock findings

A

Decreased blood pressure
Rate cardia
Warm extremities
Motor/sensory disturbance

CRITICAL CARE (2 decks)

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