shock

Question 1

shock types

Answer 1

hypovolemic
cardiogenic (obstructive subtype)
distributive

Question 2

hypovolemic shock

Answer 2

decreased CO and PCWP
CVP < 5mmHg
increased SVR

Question 3

cardiogenic

Answer 3

decreased CO
increased PCWP and SVR
included obstructive shock

Question 4

distributive shock

Answer 4

vasodilatory 
'warm shock'
increased CO
decreased SVR and PCWP (can be normal)
normal to high central venous O2 saturation (CVOS)

Question 5

clinical shock markers

Answer 5

SPB 1

Question 6

Tx of cardiogenic shock

Answer 6

upright, O2
low BP- dobutamine
normal or high BP- nitroglycerin or nitroprusside w/loop diuretic
AF- esmolol 
Post MI- NE, dopamine if hypotensive

Question 7

becks triade for cardiac tamponade

Answer 7

distended neck vv
distant heart sounds
distressed BP (hypotension)

Question 8

cardiac tamponade EKG

Answer 8

electircal alterans

Question 9

causes of obstructive shock

Answer 9

tension pneumothorax
pericardial disease
PE
cardiac tumor
left atrial mural thrombus
obsturctive valvular disease

Question 10

SIRS

Answer 10

Temperature
HR > 90
R > 20
WBC >12,000 or 10% band

Question 11

sepsis

Answer 11

SIRS + suspected or present source of infection
glucose >140
altered mentation
edema > 20ml over 24hours

Question 12

severe sepsis

Answer 12

organ dysfunction, only need 1
hypotension
hypoperfusion
lactic acidosis

Question 13

acid-base in SIRS

Answer 13

respiratory alkalosis -> lactic acidosis

Question 14

septic shock

Answer 14

cannot maintain MAP >60 after fluids

SVR <800

Question 15

9 steps for early sepsis protocol

Answer 15

w/in 2 hours
serum lactate
2 blood cultures
2 18gauge lines
antibiotics
2L NS
CBC and BMP
O2 sat>90%
start NE is shock present
transfer for lactate >4, systolic BP <60 after 2 L NS

Question 16

septic shock Tx

Answer 16

maintain CVP at 8-12
maintain MAP >65 and CI 2-4
maintain CVOS >70%
reduce lactate by 20% in 2 hours

Question 17

maintain CVP

Answer 17

at 8-12

give fluids 5L in 6hrs

Question 18

maintain MAP and CI

Answer 18

>65, 2-4
vassopressors
NE
phenylephrine for warm shock
Epi for anaphylactic

Question 19

maintain CVOS

Answer 19

> 70%
PRBC to maintain hemacrit
then dobutamine as inotropic therapy

Question 20

septic shock and steroids

Answer 20

hydrochortisone 50mg every 6 hours