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Multisystem Faculty (Final) > Shock + RUSH Protocol > Flashcards

Shock + RUSH Protocol Flashcards

1
Q

State of inadequate tissue perfusion leading to hypoxia and cell death

A

Shock

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2
Q

Inflammatory response to microorganisms, or invasion of sterile host tissue

A

Infection

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3
Q

Viable bacteria in the blood

A

Bacteremia

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4
Q

T > 38 or < 36

HR > 90

RR > 20

WBC > 12,000 or < 4,000 or > 10% bands

PaCO2 < 35

A

SIRS

(must meet at least 2 of the criteria)

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5
Q

SIRS

+

Source of Infection

A

Sepsis

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6
Q

Hypotension

+

Severe Sepsis

aka hypoperfusion causing hypoxia and cell death

A

Septic Shock

Severe Sepsis = sepsis + lactic acidosis, SBP < 90 or a drop > 40

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7
Q

Who gets septic shock?

A

Anyone can

Increased risk for immunocompromised (DM, Medicated, Asplenic, etc.)

Increased risk for those at “extremes of age”

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8
Q

Tx for septic shock

A

Abx (early goal directed therapy)

+

Fluid (most often crystalloid)

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9
Q

4 Classic Types of Shock

A
  1. Hypovolemic (secondary to hemorrhage or loss of other bodily fluid)
  2. Cardiogenic
  3. Distributive (sepsis, anaphylaxis, neurogenic shock)
  4. Obstructive (pericardial tamponade, tension pneumo, PE)
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10
Q

Classes of Hemorrhagic Shock

A

Class I-IV

You can lose up to 30% of your blood volume (Class II) before your BP begins to decrease (Class III)

Class IV: >2000 ml blood loss (40% or more),

HR > 140, RR > 35

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11
Q

Tx for Hemorrhagic Shock

A

Find the bleeding
Stop the bleeding

*Reverse coagulopathies (ASA, Warfarin)

Replace blood and support patients

*Mainly applies to older patients

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12
Q

Which areas of the body are you most likely to bleed to death from?

A

Abdomen

Femur/Thigh

Pelvis

Chest

Externally

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13
Q

When do you start hypotensive resuscitation for someone in hemorrhagic shock?

A

If their BP drops below 80

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14
Q

Difference between hypotensive resuscitation and tx for hypovolemic shock

A

Hypotensive resuscitation = give blood

Hypovolemic shock = give crystalloid

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15
Q

Risk factors for anaphylaxis

A

Poorly controlled asthma

Previous anaphylaxis

Previous exposure to sensitizing agent

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16
Q

Most common causes of anaphylaxis

A

Antibiotics (esp. B-lactam): 400-800 deaths

Insects: < 100 deaths

Food: 11 deaths

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17
Q

Severe systemic hypersensitivity that may include hypotension or airway compromise

A

Anaphylaxis

IgE-dependent mast cell, basophil release

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18
Q

Anaphylactoid

A

Non-IgE mediated

Same final common pathway as anaphylaxis

No sensitizing exposure required

19
Q

Primary Tx for anaphylaxis

A

Epi (no absolute contraindications)

0.1 mg IV or 0.3-0.5 mg IM (i.e., give less potent when IV)

20
Q

Stabilizing Treatment for Anaphylaxis

A

Intubate sooner rather than later

Fluid resuscitation for hypotension

Steroids

Antihistamines (H1 & H2)

Tx bronchospasm

Glucagon (if on β-blockers)

21
Q

Neurogenic Shock

A

Disruption of sympathetic outflow:

Blunt trauma (usually C-spine)

Sympathetic roots T1-L2

Unopposed vagal tone

Hypotension + Bradycardia

22
Q

Neurogenic Shock vs Spinal Shock

A

Spinal shock = total loss of spinal reflex activity AT AND BELOW injury level

23
Q

Tx of Neurogenic Shock

A

Assume hemorrhage (even w/ bradycardia)

Stop secondary injury

Fluids

Pressors

24
Q

Cardiogenic Shock

A

Decreased cardiac output despite adequate volume (tissue hypoperfusion)

Usually results from AMI

25
Q

Diagnosis of Cardiogenic Shock

A

EKG

Echo

CXR

Labs

Monitoring

26
Q

Tx of Cardiogenic Shock

A

ABC support

Reperfusion of MI (thrombolytics, PCI)

Intraaortic Balloon Pump

27
Q

Only type of shock where CVP (central venous pressure is HIGH)

A

Cardiogenic

DO NOT give fluids

“Big toe” should feel cool

28
Q

Only type of shock that you give Blood

A

Hemmorhagic

CVP should be low

“Big toe” should feel cool

29
Q

What types of shock will make your “big toe” (extremities) warm?

A

Septic

Anaphylactic (normal CVP)

Neurogenic

30
Q

When are pressors helpful?

A

Typically, they do not improve meaningful outcomes

Exception = anaphylaxis (i.e., EPI)

31
Q

Norepinepherine

(Levophed)

A

Pressor used for sepsis

32
Q

Dobutamine

A

Pressor used for cardiogenic shock

(strict β stimulant so watch out for drop in BP via vasodilation)

33
Q

85 y.o. woman found unresponsive beside bed

Only available history = Alzheimer’s

HR 115, BP 70, PO2 88%, Glucose 170

What Dx is most likely?

A

Septic Shock

KEY FINDINGS: extremities are cool, bruising/crepitus at pelvis, Hgb low, and CVP low

…change diagnosis to Hemorhagic shock (pelvic fx)

34
Q

What 3 categories does RUSH access?

A

Pump (Estimate of EF, Tamponade, PE)

Tanks (IVC, eFast, Pulmonary)

Pipes (Aorta, DVT)

35
Q

Which transducers are used during the FAST exam?

A

Phased array for cardiac (small footprint is good for b/w ribs)

Curvilinear array for abdomen (45x as many crystals = higher quality, but more rib shadows)

36
Q

What 3 things are you looking for with the heart on ultrasound?

A

Contractility

Pericardial Effusion/Tamponade

RV strain (indictive of PE)

37
Q

What are the views of the heart on ultrasound?

A

Parasternal (short/long)

Subxiphoid

Apical 4 Chamber

38
Q

When do you want to monitor the IVC more closely on ultrasound?

A

During volume resuscitation

or

When the following are suspected:

Tamponade, PE, Tension pneumo (all would show abnormally large IVC)

39
Q

Beside the heart, what are the other 3 views for the FAST exam

A

RUQ, LUQ, Pelvic

40
Q

How to look for a tension pneumo on ultrasound

A

Use high frequency linear array

Look for abscence of sliding (use M mode if not sure)

41
Q

What is a “comet tail” on ultrasound

A

An artifact created by fluid in the lungs (indicating pulmonary edema)

42
Q

AAA on ultrasound

A

Abdominal Aortic Aneurysm

Look for aorta that is > 3 cm (abnormal)

Must measure from outer wall to outer wall

Remember: 2/3 of AAA’s rupture retroperitoneally (meaning they will not show up on US when doing an eFAST, must rely on measurement)

43
Q

Pericardial effusion

vs

Pleural effusion

Difference on ultrasound

A

Pericardial = “rat tail”

A person can have both

44
Q

PATCH MD

A

P: pulmonary embolism

A: acidosis

T: tension pneumo

C: cardiac tamponade

H: hyopvolemia, hypoxia, hypothermia, hypo/hyperkalemia

M: MI

D: drugs

Ultrasound can diagnosis everything in bold

Multisystem Faculty (Final) (4 decks)

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