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ACNP Certification > Shock states/Hemodynamics > Flashcards

Shock states/Hemodynamics Flashcards

1
Q

CVP

A

Pressure in the RA: Indicates right heart function

0-6

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2
Q

MAP

A

SBP+2(DBP)/3

Avg force in the arterial system

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3
Q

PAP Pulmonary Artery Pressure

A

Measure of the systolic and diastolic pressures in the pulmonary artery

15-25 / 5-15

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4
Q

In what conditions is the PAP elevated?

A

Increased fluid such as hypervolemia and pulmonary HTN

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5
Q

In what conditions is the PAP decreased?

A

Decreased fluid such as hypovolemia

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6
Q

PCWP Pulmonary capillary wedge pressure

A

Measure of the pressure in the LV at end-diastole

Measures maximal stretch

6-12

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7
Q

PWCP is increased in what conditions?

A

Hypervolemia, stiff ventricle

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8
Q

PWCP is decreased in what conditions?

A

Hypovolemia

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9
Q

High PCWP is a reflection of the tendency to develop what condition?

A

Pulmonary edema

Keep # at lowest end possible that keeps adequate cardiac performance

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10
Q

CO Cardiac Output

A

HR x SV

4-8 LPM

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11
Q

What conditions increase CO?

A

Inotropic agents, hypervolemia

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12
Q

What conditions decrease CO?

A

Drugs that decrease contractility, hypovolemia, BB

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13
Q

CI Cardiac Index

A

CO / BSA

2.5 - 4 LPM

Measurement of contractility

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14
Q

SVR Systemic Vascular Resistance

A

(MAP - mean CVP x 80)/ CO

800-1200

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15
Q

SVO2 Mixed venous O2 Saturation

A

continuous measure of mixed venous O2 by the pulmonary artery catheter

60-80%

Continuously measures the effectiveness of peripheral O2 delivery

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16
Q

Wht does SVO2 > 80% imply?

A

Decreased tissue extraction of O2

FiO2 > need,

Hypothermia

sepsis

Shift to left of oxyHg curve

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17
Q

What does SVO2 < 60% imply?

A

Increased tissue extraction of O2

decreased FiO2

Anemia

increased O2 demand such as fever, increased work of breathing, shivering

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18
Q

All numbers are low except SVR

A

Hypovolemic shock

loss of volume, SVR is high to compensate

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19
Q

List four shock states

A

Hypovolemic

Cardiogenic

Distributive

Obstructive

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20
Q

List 3 types of distributive shock

A

Septic

Anaphylactic

Neurogenic

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21
Q

List two shock states with a high CVP

A

Obstructive

Cardiogenic

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22
Q

Decreased CO/CI and SVO2, Increased CVP, PCWP, SVR

A

Cardiogenic shock

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23
Q

Wht is the only shock state with an initially high PWCP?

A

Cardiogenic

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24
Q

Shock state where all numbers are low?

A

Distributive

25
Q

Definition of distributive shock

A

Characterized by vasodilation, decreased intravascular volume, reduced PVR, loss of capillary integrity

26
Q

What type of distributive shock has initially high CI with everything else low?

A

Septic shock

27
Q

Decreased CO/CI and PCWP, increased CVP, PVR, SVR, SVO2

A

Obstructive Shock

28
Q

Most common cause of obstructive shock?

29
Q

Why is the CVP elevated in obstructive shock?

A

Blood backs up creating higher pressure

30
Q

Why is the PCWP decreased in obstructive shock?

A

Blood can’t get there due to obstruction so the # is low

31
Q

CVP

PAP

PCWP

CO

CI

SVR

SVO2

A

0-6

15-25 / 5-15

6-12

4-8

2.5-4

800-1200

60-80%

32
Q

List 4 common causes for hypovolemic shock

A

Bleeding/trauma

Burns

DKA/HHNK

Dehydration

33
Q

List 5 causes for cardiogenic shock

A

MI

Dysrhythmia

Pericardial tamponade

Pulmonary edema

Acute valvular regurg

Acute VSD or aneurysm

34
Q

Underlying cause of anaphylactic shock

A

IgE mediated reaction that occurs shortly after exposure to allergen

35
Q

1st line tx for anaphylactic shock?

A

Diphenhydramine

Then Epi

36
Q

Underlying cause of neurogenic shock?

A

Loss of peripheral vascular tone due to spinal cord injury or regional anesthesia

37
Q

Underlying cause of Obstructive shock?

A

Inadequate cardiac output due to impaired ventricular filling

38
Q

What is the indiction for SQ epi in anaphylactic shock?

A

Respiratory distress / stridor

39
Q

Which hemodynamic measurement indicates right heart function?

40
Q

Which hemodynamic measurement indicates pressure in the LV at end diastole?

41
Q

Which hemodynamic measurement indicates pressures in the pulmonary artery?

A

PAP

15-25 / 5-15

42
Q

Which type of shock includes bradycardia?

A

Neurogenic

Any question with bradycardia=neurogenic (lack of feedback, body doesn’t get the signal that they are vasodilated)

43
Q

Acute cardiac tamponade is what kind of shock?

A

Obstructive shock

44
Q

List samples of obstructive shock

A

PE

Cardiac Tamponade

Tension pneumo

Valvular obstruction

45
Q

Tx for obstructive shock

A

Fluid

Remove obstruction (needle thoracostomy, pericardial tap)

46
Q

Low Contractility is what type of shock?

A

Cardiogenic

47
Q

Dilated=

A

Distributive

48
Q

Low CO/CI=

A

Cardiogenic

49
Q

Low CVP and PCWP indicate what?

A

Hypovolemia

50
Q

Everything is low except SVR?

A

Hypovolemic

51
Q

Low SVO2 occurs in what conditions?

A

Low contractility/decreased CO, anemia, increased o2 demand (shivering fever, increased work of breathing)

52
Q

High SVO2 occurs in what conditions?

A

dead bowel, crush injuries, sepsis

indicates decreased tissue extraction of O2

53
Q

Negative inotropes

A

beta-blockers, calcium channel blockers, and antiarrhythmic medicines

54
Q

Positive inotropes

55
Q

What is the preferred vasoactive agent to treat cardiogenic shock with low output and increased afterload?

A

Dobutamine

56
Q

first-choice vasopressors to correct hypotension in septic shock?

A

norepinephrine (levophed) and dopamine

57
Q

2 step tx for neurogenic shock?

A

IVF

Vasopressors

58
Q

Tx for anaphylactic shock?

A

IVF

Hives= benadryl

Respiratory distress/stridor=epi

Intubate first, then epi!!!!!

59
Q

What happens to the CVP, PCWP, and SVO2 in the end stages of septic shock

A

The numbers get high after initially being low due to pump failure

ACNP Certification (17 decks)

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