Shock Pharm

Question 1

The predominant physiologic variable associated with hypovolemic shock is

Answer 1

Decreased preload

Question 2

The predominant physiologic variable associated with cardiogenic shock is

Answer 2

Decreased pump function of the heart

Question 3

The predominant physiologic variable associated with distributive shock is

Answer 3

Decreased afterload

Question 4

What is the initial treatment for hypotension observed in shock?

Answer 4

Crystalloid (saline)

• about 30 mL/kg
• DO NOT give fluid in cardiogenic or obstructive shock

Question 5

Treatment for anaphylactic shock?

Answer 5

Immediate IM Epinephrine

• B1 for increased contractility
• B2 for bronchodilation
• a1/a2 to increase vascular tone in organs

may also add antihistamine and/or inhaled albuterol

Question 6

Treatment for Cardiogenic shock

Answer 6

Goal is to get the heart pumping!!!

Norepinephrine (a1 and B1 agonist)

• can also give DA (B and a agonism)
• give dobutamine in refractory cases (B1 agonism)
• DO NOT GIVE FLUIDS

Question 7

Treatment for septic shock

Answer 7

Goal is to restore blood pressure (TPR)

Norepinephrine is first line choice (a1 and B1 agonism)

• can substitute with epinephrine
• substitute DA if bradycardia

*IV abx

• can add vasopressin (V1 mediated vasoconstriction)
• only add phenylephrine if NE causes arrhythmia
• add dobutamine if needed for inotropy

Question 8

Can low dose corticosteroids help improve shock reversal?

Answer 8

Yes!

Question 9

Treatment for obstructive shock due to tension pneumothorax (air in pleural space compressing vena cava)?

Presents as tracheal deviation, increased RR with decreased lung sounds on affected side, JVD, rapid and severe hypotension, tachycardia -> bradycardia

Answer 9

Needle decompression and chest tube

Question 10

Treatment for obstructive shock due to cardiac tamponade?

Presents as increased RR with distress, tachycardia with JVD and muffled heart sounds, narrow pulse pressure, decreased peripheral pulses

Answer 10

Pericardiocentesis

Question 11

Treatment for obstructive shock due to pulmonary embolism?

Presents as increased RR with distress, tachycardia, cyanosis and chest pain, hypotension, venous congestion, poor perfusion

Answer 11

Anticoagulation

*after confirmation with imaging (CT scan)

Question 12

Treatment for obstructive shock due to percarditis (thickened pericardium prevents heart from expanding to fill)?

Answer 12

OTC NSAID pain relievers (aspirin, naproxen, ibuprofen)

Colchicine (disrupts white cell migration)

Corticosteroids (if above ineffective)

Abx (if bacterial)