Shock/Sepsis/Trauma

Question 1

Shock w/u?

Answer 1

CBC
BUN (CMP)
UA
EKG
CXR
UPT

Lactate

Question 2

TX shock?

Answer 2

2x IV - crystalloids

+/- pressors

Question 3

Distributive shock TX/w/u?

Answer 3

Broad ABX
CXR, Ua/UC, BC x2 (3 if endo)
Head CT / LP

Question 4

Cardiogenic shock causes + w/u?

Answer 4

ACS, arrhythmia, valvular issue

Enzymes/EKG

Question 5

Obstructive shock causes?

Answer 5

PE, tamponade— increased venous resistance

PTX —————— decreased venous resistance

Question 6

SIRS criteria?

Answer 6

T >100.4, less than 96.8
RR >20
BPM > 90
WBC >12,000, less than 4,000

Question 7

Signs of End organ damage?

Answer 7

Heart/vascular
- SBP  less than 90
- MAP less than 70
Kidney
- Creat > 2
- UOP  less than 0.5 ml/kg/hr
Liver
- Bili >2
- INR >1.5
- PT >60

Muscle
- Lactate >2

Question 8

Sepsis w/u?

Answer 8

CBC
CMP
PT/INR
B/C x 2 or 3
UA/UC
CXR
LP +/- CT
Joint Aspiration

Question 9

Sepsis early goals?

Answer 9

Central line - CVP 8-12
Blood transfusion +/- dobutamine
Lactate clearancy –> 2 or 10% decrease

Question 10

Sepsis within 3 hrs:

Answer 10

GET: Lactate and B/C x2
GIVE ABX
- fluids if low BP pr lactate >4
- 30 ml/kg crystalloids

Question 11

Sepsis within 6 hrs:

Answer 11

Pressors if no response to fluids
Document fluid status
Repeat lactate if >4

Question 12

Trauma order of evaluation?

Answer 12

ABCDE
Log roll
XR +FAST
secondary survery

Question 13

Trauma w/u (ALWAYS DO)?

Answer 13

Cross + type
Chest and Pelvis XR
Cervical XR
FAST
CBC, ABG, CMP, UA
Ethanol
EKG (looking for etiology if unclear)

Question 14

5 things to clear c-spine?

Answer 14

Non-tender
no AMS or intoxication
No history of injury
No distracting injuries
No neuro deficits

Question 15

Specific thing to watch with pulm contusion?

Answer 15

Will get worse with too much fluids

Question 16

Worrisome signs on abdomen?

Answer 16

Cullen sign = periumbilical
Grey-Turner = Flank bruise
Seat-Belt Sign