SIRS and Shock

Question 1

Adults SIRS Criteria

Answer 1

temp more than 38/100.4 or less than 36/96.8
heart rate greater than 90
rr greater than 20 or paco2 less than 32
wbc more than 12k, less than 4k or more than 10% bands

Question 2

Peds SIRS Criteria

Answer 2

temp more than 38.5 (101.3) or less than 36 (96.8)
tachycardia or bradycardia if less than 1 year
tachypnea or mechanical ventilation
abnormal lecukocyte count or more than 10% bands

Question 3

Sepsis

Answer 3

SIRS + source of infection

Question 4

Severe Sepsis

Answer 4

sepsis + organ dysfunction (hypotension, hypoperfusion)

Question 5

Septic Shocks

Answer 5

severe sepsis despite adequate fluid resuscitation

Question 6

Multiple Organ dysfunction syndrome

Answer 6

evidence of 2 or more organs failing

Question 7

tachycardia/pnea for peds

Answer 7

mean rate more than 2 standard deviations above normal

Question 8

bradycardia - peds

Answer 8

mean heart rate less than 10th percentile for age

Question 9

severe sepsis in peds

Answer 9

associated with cardiovascular dysfxn, ARDS, or dysfxn in two or move organ systems

Question 10

goal CVP

Answer 10

12

Question 11

a1 and a2 receptors

Answer 11

blood vessels

vasoconstriction

Question 12

b1 receptors

Answer 12

myocardium
inotrope
chronotrope

Question 13

inotrope

Answer 13

?

Question 14

chronotrope

Answer 14

?

Question 15

b2 receptors

Answer 15

blood vessels

vasodilation

Question 16

d1 receptors

Answer 16

renal

vasodilation

Question 17

norephineprhine receptors

Answer 17

a1

ba

Question 18

norephinephrine AE

Answer 18

arrhythmias

Question 19

pnehylephine receptors

Answer 19

alpha 1

Question 20

epinephrine receptors

Answer 20

potent b1 (1st)
alpha 1 (2nd)
some b2

Question 21

dopamine receptors

Answer 21

low dose d1
medium dose b1
high dose a1

Question 22

dobutamine

Answer 22

b1 and b2

Question 23

dobutamine used for

Answer 23

cardiogenic shock and htn (decompensated HF)

Question 24

septic shock, give

Answer 24

NE

PE if arrhythmia develops

Question 25

cardiogenic shock, give

Answer 25

dopamine if hypotension

dobutamine if hypertension

Question 26

compliance

Answer 26

delta v / delta p

Question 27

preload =

Answer 27

gas tank

Question 28

contractility =

Answer 28

engine

Question 29

afterload =

Answer 29

exhaust system
tension or stress developed in wall of LV during ejection
in other words the end load against which the heart contracts to eject blood

Question 30

hypovolemic shock primary problem

Answer 30

decreased preload

Question 31

hypovolemic - contractility

Answer 31

initially increases, increase SV

Question 32

hypovolemic - afterload

Answer 32

increase, trying to vasoconstrict

Question 33

cardiogenic shock - primary problem

Answer 33

contractility decreased

Question 34

cardiogenic preload

Answer 34

increased or normal, heart isn’t pumping

Question 35

cardiogenic afterload

Answer 35

increased, because want to keep bp up

Question 36

treatment of cardiogenic shock

Answer 36

afterload reduction (nitrates)

Question 37

neurogenic - primary problem

Answer 37

decreased afterload

Question 38

what causes neurogenic shock

Answer 38

sympathetic damage, c6/7 or above

Question 39

neurogenic - preload

Answer 39

up or down
vasodilation causes preload to go down
pooling of blood causes preload to go up

Question 40

neurogenic contractility

Answer 40

increased

Question 41

sepsis - primary problem

Answer 41

decreased preload, contractility and afterload

Question 42

swann meausres

Answer 42

pulmonary artery pressure

best estimate of what’s getting into LA and LV

Question 43

normal SVO2

Answer 43

76%, optimal above 70%

Question 44

svo2 too low

Answer 44

not getting enough oxygen

Question 45

svo2 too high

Answer 45

tissues not absorbing oxygen, person is dead