Shock Management

Question 1

List the three forms of calcium that exist in the body

Answer 1

Chelated
Bound
Ionized

Question 2

What are the components of the “death diamond”?

Answer 2

Hypothermia
Hypocalcemia
Coagulopathy
Acidosis

Question 3

What is the shock index equation?

Answer 3

HR / SysBP = SI
The higher the number, the worse the SI

Question 4

What is the permissive hypotension goal in a patient with no TBI?

Answer 4

80-90 sys

Question 5

What is the permissive hypotension goal in a patient with TBI?

Answer 5

100-110 sys

Question 6

Using the Frank-Starling curve and Marik-Phillips curve, explain the consequences of continued liberal fluid administration

Answer 6

Rule of diminishing returns. The higher the stroke volume, and higher preload, the less effect continued volume will change the FS curve towards the right plateau. Inversely, the higher the SV, the higher the preload, the more substantial the extra vascular lung water (EVLW)

Question 7

Write the Pulse Pressure Variation (PPV) equation

Answer 7

PPV(%) = [(PPmax - PPmin) / AveragePP] x 100

Question 8

Under what PPV would be considered non fluid responsive?

Answer 8

<9%

Question 9

Write the traditional Starling equation.

Answer 9

Question 10

In the traditional Starling equation, what is the k constant?

Answer 10

Filtration coefficient

Question 11

In the traditional Starling equation, what is the ohm constant?

Answer 11

Reflection coefficient

Question 12

In regards to the traditional Starling equation and the revised Starling equation, what component has changed?

Answer 12

It takes the glycocalyx into account. The only part of the equation that changes is the end, (instead of pi c - pi i, it is pi c - pi g)

Question 13

What equations do these two lines represent, and what is the intersection point called?

Answer 13

Traditional and revised Starling equation
J-point

Question 14

On the traditional Starling equation graph, the negative part of the line on the Y-axis assumes what?

Answer 14

Negative suggests flow moving back into the vessels

Question 15

On the revised Starling equation graph, what does the graph describe as the line moves left towards zero?

Answer 15

The fluid is not moving out of the vessels

Question 16

In the Starling equation graph, in what direction would the J-point shift if there was vascular leakage?

Answer 16

Left

Question 17

What two parts of the revised Starling equation does sepsis effect?

Answer 17

ohm (reflection coefficient- how easy it is for proteins to move0
pi g (the glycocalyx)

Question 18

What part of the revised Starling equation is affected with colloid administration?

Answer 18

pi c
Which makes sense, because it overall decreases J, which favors movement of fluid into the vessels

Question 19

Write the UNITS for each part of the DO2 equation.

Answer 19

0.003 (dissolved O2 - mLO2/dL/mmHg) x PaO2 (mmHg) + 1.34 (mL/O2 per g/Hgb) x SaO2 (%) x Hgb (g/dL) x HR (BPM) x SV (mL/beat)

Question 20

Label the graph for oxygen supply and demand (normal and pathologic states)

Answer 20

Question 21

In the graph for oxygen supply and demand (DO2 v VO2), what would the difference between two points on the area of the plateau?

Answer 21

Points on the right have a lower oxygen extraction than B

Question 22

Write the oxygen extraction ratio equation

Answer 22

OER = VO2/DO2x 100
OER = CavO2 / CaO2

Question 23

When ScvO2 is low, what are 3 causes each of decreased DO2 and increased VO2?

Answer 23

Decreased DO2: anemia*, bleeding, hypovolemia, hypoxia, heart failure
Increased VO2: pain, agitation, shivering, seizure, fever

Question 24

When ScvO2 is high, what are 3 causes each of increased DO2 and decreased VO2?

Answer 24

Increased DO2: transfusion, fluids, oxygen, ionotropic
Decreased VO2: sedation, analgesia, hypothermia, decreased O2 extraction, sepsis