Week 4 - Critical Illness

Question 1

What is the first therapy (and dose) given for sepsis-induced hypoperfusion?

Answer 1

IV Crystalloids (30mL/kg) within first 3 hours

Question 2

What is the first therapy given for septic shock?

Answer 2

Norepinephrine

Question 3

Alternative medications given for septic shock?

Answer 3

• Epinephrine
• Low dose vasopressin (0.03 units/min)
• Dobutamine (myocardial dysfunction)

Question 4

What measures can be used to decrease risk for vasopressor extravasation?

5

Answer 4

• Large Bore IV
• Antecubital or higher
• Don’t use > 4 hrs
• Smallest concentration of NE (4mg/250mL
• CVL

Question 5

When would you give steroids to a septic shock patient?

Answer 5

When they’re hemodynamically unstable

Question 6

What drug/dose would you give for a hemodynamically unstable septic shock patient?

Steroid

Answer 6

Hydrocortisone 200mg/day split over 4 doses

Question 7

MAP goal in septic shock?

Answer 7

• > 65 mmHg

Question 8

In the absence of these symptoms, the transfusion trigger is __________?

Answer 8

Absence of:
* Myocardial ischemia
* Severe hypoxemia
* Acute hemorrhage
< 7 g/dL

Question 9

How much blood loss is associated with Class I Hemorrhagic shock?

What about HR?

Answer 9

< 750mL

• 60-100 bpm

Question 10

How much blood loss is associated with Class II Hemorrhagic shock?

What about HR?

Answer 10

750-1500mL

• 101-120 bpm

Question 11

How much blood loss is associated with Class III Hemorrhagic shock?

What about HR?

Answer 11

1500-2000mL

• 121-140 bpm

Question 12

How much blood loss is associated with Class IV Hemorrhagic shock?

What about HR?

Answer 12

> 2000mL

• > 140 bpm

Question 13

What is considered MTP?

Answer 13

• > 10 units within a 24 hr period
  or
  Replacement of whole body blood volume

Question 14

Which shock states includes bradycardia as a symptom?

Answer 14

Neurogenic Shock