Shock Lecture Powerpoint

Question 1

Shock definition

Answer 1

Clinical condition characterized by signs and symptoms which arise when cardiac output is insufficient to fill the arterial tree with blood under sufficient pressure to provide organs and tissues with adequate blood flow - a failure of perfusion

Question 2

Mean arterial pressure MAP =

Answer 2

CO x PVR (peripheral vascular resistance)

Question 3

Cardiac output CO=

Answer 3

HRxSV

SV (EDV x contractility)

Question 4

Most common type of distributive shock

Answer 4

-Sepsis (sepsis is the next step of SIRS -systemic inflammatory response phenomenon)

Question 5

Nonhemorrhagic hypovolemic shock is most often due to ___ losses

Answer 5

Gastrointestinal

Question 6

Third space losses

Answer 6

A type of nonhemorrhagic hypovolemic shock where fluid in a potential space sees filling due to capillary leakage (think peritoneum or pleura) and this depletes intravascular volume overall

Question 7

4 classes of hemorrhage

Answer 7

I - Small amount of blood loss (10-19%), BP, HR, RR, and U/O remain the same
II - Decreased pulse pressure (20-29%), HR >100, RR increase, U/O decrease
III - (30-39%)decreased BP, HR >120, RR >30, U/O oligouric
IV - up to 40-50% blood loss, BP very low, >140HR, RR>40, aneuric

Question 8

Massive transfusion protocol

Answer 8

1:1:1 of packed RBC (first choice O neg, Op pos and type specific are alternatives), plasma, and platelets

Question 9

Neurogenic shock pathophysiology

Answer 9

Dilation of the arterial and some degree of the venous side of the systemic circulation

Question 10

Examples of obstructive shock (5)

Answer 10

(this is the least common type)

• PE
• tension pneumothorax
• pericardial tamponade
• constrictive pericarditis
• abdominal compartment syndrome

Question 11

Low pulse pressure or decreased cardiac output indicates what type of shock origin? (2)

Answer 11

• cardiogenic

- hypovolemic

Question 12

Mixed venous O2

Answer 12

A measure of the oxygenation of the venous blood entering the pulmonary artery with a catheter (the least oxygenated blood in the body), should normally be 65-75% saturated, if lower then indicates worse condition of shock than if higher because that implies inadequate perfusion of the tissue at the periphery which therefore draws out more oxygen

Question 13

Swan ganz catheterization of the right heart to obtain pulmonary capillary wedge pressure gives a measure of ___

Answer 13

left atrium

Question 14

6 things that can be manipulated in the treatment of shock to help preserve pressure

Answer 14

• systemic arterial pressure (MAP)
• cardiac preload
• blood o2 carrying capacity
• treat the underlying cause
• expansion of intravascular space with warm fluids***
• monitor response to intervention

Question 15

Hemorrhagic shock treatment (3)

Answer 15

• 2 large bore IV’s
• normal saline and lactated ringer crystalloid (class I-II)
• blood/plasma/platelet/hypertonic saline (3% - draws out stores in interstitial space) (class III-IV hemorrhages)

Question 16

Blood delivery to the heart occurs during what phase of the cardiac cycle?

Answer 16

Diastole

Question 17

Cardiogenic shock diagnosis (2)

Answer 17

• pumonary artery catheterization

- echocardiogram of left ventricle

Question 18

How is cardiogenic shock treated? (3)

Answer 18

• balloon pump catheterization
• norepi
• thrombolytic drugs

Question 19

SIRS criteria (4)

Answer 19

• temp >38 or <36C
• HR >90bpm
• RR >20 or PaCO2 <32 (respiratory alkalosis)
• WBC count >12000 or <4000 or >10% immature bands

Question 20

qSOFA criteria for sepsis (3)

Answer 20

• RR >22
• SBP <100
• altered mental status (due to suspected infection)

Question 21

Predisposing risk factors for sepsis (6)

Answer 21

• underlying disease
• increasing age
• antibiotic use
• immunosuppresion
• malignancy
• hospitalization or indwelling catheter/ventilator

Question 22

Sepsis treatment options (3)

Answer 22

• administer broad spectrum antibiotics piperacillin, ampicillin
• steroids that mute the immune response (leukotriene storm)
• initiate pressors as needed (norepi)

Question 23

Goal directed therapy for sepsis (4)

Answer 23

Meet the following criteria:

• Central venous o2 sat of > or =70
• central venous pressure > or =8-12
• mean arterial pressure > or = 65
• urine output > or = .5cc/kg/hr

Question 24

Neurogenic shock etiologies (4)

Answer 24

• spinal anesthesia
• vagal stimulation
• cord transection
• NOT head trauma

Question 25

Widened pulse pressure might indicate what sources of shock? (2)

Answer 25

• neurogenic

- vasodilatory shock

Question 26

Neurogenic shock treatment options (3)

Answer 26

• trendelenberg position
• IV fluids
• Pressors

Question 27

Why don’t you use antihistamines for anaphylaxis?

Answer 27

Because most mast cells have already degranulated at the point of anaphylaxis presence