Shock Syndromes

Question 1

What is condition is shock linked to?

Answer 1

hypotension

Question 2

What are the 4 types of shock

Answer 2

-Hypovolemic
-Distributive
(Sepsis/Septic Shock)
-Cardiogenic
-Obstructive

Question 3

What is hypovolemic shock?

Answer 3

inadequate intravascular volume to meet oxygen and metabolic needs

Question 4

What are the causes of hypovolemic shock?

Answer 4

Hemorrhage & Dehydration

Question 5

What is halmark sx of dehydration linked to hypovolemic shock?

Answer 5

Tachycardia

Question 6

What is the tx for shock?

Answer 6

Fluic therapy

• Crystalloids
• Colloids
• Blood products

Question 7

*What is 1st line tx for hypovolemic shock?

Answer 7

Crystalloids

Question 8

What is the SE of crystalloids?

Answer 8

volume overload and electrolyte disturbances

Question 9

Describe colloid tx

Answer 9

Hydrostatic pressure and colloid oncotic pressure

Question 10

Are crystalloids or colloids more preferred tx for hypovolemic shock?

Answer 10

Crystalloids

Question 11

What is the AE of blood products?

Answer 11

Transfusion reactions &

Infection

Question 12

*What neurotransmitters are preserred for vasopressor therapy?

Answer 12

Norepinephrine and dopamine

Question 13

*What is the MOA of vasopressor therapy?

Answer 13

Cause vasoconstriction through stimulation of alpha-1 adrenergic receptors

Question 14

*What is the MAP therapy goal?

Answer 14

(MAP > 60 mmHg) w/i 1 hr

Question 15

*What is the leading cause of distributive shock?

Answer 15

Septic shock

Question 16

*What is the hallmark of septic shock?

Answer 16

• decrease in systemic vascular resistance with a low SVR (systolic)

Question 17

What is the most common cause of death in ICU patients?

Answer 17

Septic shock

Question 18

Define criteria for Systemic inflammatory response syndrome (SIRS)

Answer 18

Inflammatory response to a variety of clinical insults (infectious and non-infectious), manifested by 2 or more of the following:

• Temp >38ºC (100.4ºF) or 90 beats/min
• Respiratory rate >20 breaths/min or PaCO2 12,000 cells/mm3, 10% immature forms

Question 19

What is the goal of Tx for Septic shock/sepsis?

Answer 19

Restore blood pressure and prevent organ dysfunction

Question 20

What is the etiology of sepsis?

Answer 20

Gram + organisms

S. aureus, S. pneumoniae, coagulase-negative Staph, Enterococcus

Question 21

What is the greatest risk for sepsis?

Answer 21

Hospitalized patients

Question 22

Define sepsis

Answer 22

Malignant or exaggerated inflammatory response

Question 23

What is the cause of SIRS

Answer 23

Loss of balance between pro-inflammatory and inflammatory mediators

Question 24

What is the key factor in sepsis response?

Answer 24

activated protein C

Question 25

What are the steps in surviving sepsis?

Answer 25

1) Stabalize pt 2) Pathogen identification and source removal 3) Antimicrobial therapy 4) Adjunctive therapy 5) Manage complications

Question 26

*What is the preferred vasopressor in septic shock?

Answer 26

Norepinephrine (NE)

Question 27

What do Beta 1 receptors do?

Answer 27

- Located in heart | - cause tachycardia

Question 28

Where are beta 2 receptors located and what do they do?

Answer 28

- stimulate lungs | - Bronchodilation

Question 29

Alpha 1 receptors are found where and what do they do?

Answer 29

- Vasculature | - cause vasoconstiction

Question 30

*Phenylephrine

Answer 30

Alpha 1 agonist only (causes vasoconstriction) | -preferred in pts with arrhythmia

Question 31

*What patients is phenylephrine preferred in?

Answer 31

pts with arrhythmia

Question 32

How soon should you start antimicrobial therapy upon sepsis recognition?

Answer 32

within 1 hr

Question 33

What corticosteroid is given as adjunctive therapy?

Answer 33

Hydrocortisone

Question 34

What is an AE of adjunctive therapy for sepsis?

Answer 34

Hyperglycemia

Question 35

What injury are sepsis patients highly at risk for?

Answer 35

Kidney injury