Drugs for Shock

Question 1

Hypovolemia

Preload:

Pump function:

Afterload:

Tissue perfusion:

Answer 1

Wedge pressure: Decreased

CO: Decreased

SVR: Increased

O2 Sat: Decreased

Question 2

Cardiogenic Shock

Preload:

Pump Function:

Afterload:

Tissue Perfusion:

Answer 2

Wedge Pressure: Increased

CO: Decreased

SVR: INcreased

O2 Sat: Decreased

Question 3

Distributive Shock

Preload:

Pump Function:

Afterload:

Tissue Perfusion:

Answer 3

Wedge Pressure: Decreased or no change

CO: INcreased

SVR: Decreasde

O2 SAt: INcreased

Question 4

What is the warm phase of septic shock (distributive)?

Answer 4

fluid shifts into third spaces

This is why crystalloid fluid resuscitation is always required for septic shock and is ALWAYS first line therapy

Question 5

What is the cold phase of septic shock?

Answer 5

hypotension, petichiae, etc

Question 6

What is the initial treatment for hypotension?

Answer 6

Crystalloid IV fluid 30ml/kg

(unless cardiogenic shock)

Question 7

What is the immediate treatment for anaphylactic shock?

Answer 7

Epinephrine IM

+/- antihistamine

+/- inhaled albuterol

Question 8

What are the main vasopressors for shock?

Answer 8

dopamine

NE

Epinephrine

Dobutamine

phenylephrine

vasopressin

Question 9

What is the MOA for dopamine?

Answer 9

precursor to NE

stimulates B receptors at low dose

stimulates a receptors at high dose

Question 10

What is the MOA of NE

Answer 10

stimulates vascular a receptors and B1 receptors of heart and kindey

no B2 action

Question 11

What is the MOA of epinephrine?

Answer 11

B1 R stimulator as wel as AR and B2R of vasculatur

Question 12

What is the MOA for dobutamine?

Answer 12

stimulates B1R of heart to increase rate and contractility

vasodilates periphery

Question 13

What is the MOA of phenylephrine?

Answer 13

stimulates AR, increases BP and decreases HR

Question 14

What is the MOA of vasopressin?

Answer 14

vasoconstrictor, binds to V1R in vasculature

V2 receptors in kidney to mediate antidiuretic effects

Question 15

Cardiogenic shock is caused by any form of severe heart failure including

Answer 15

MI

Arrhythmias

Mitral/Aortic valve Regurgitation

Failed valves

Rupture

Large PE

Tamponade

Question 16

NE and DA can be used to treat cardiogenic shock, but which is superior?

Low dose Da can be used to preserve what?

When is dobutamine used?

Answer 16

NE

renal function

refractory shock/systolic heart failure when low CO despite adequate filling pressure

Question 17

What are the criteria for Sepsis?

Answer 17

Temp >38.3 or <36

HR >90

RR>20

AMS

Edema

Hyperglycemia without DM

Question 18

What are some lab values seen in severe sepsis?

Answer 18

Hypotension

Lactate elevation

decreased urine output

elevated CRT, Bili

Decreased PLT

Elevated INR

Question 19

When is sepsis considered septic shock?

Answer 19

when there is sepsis-induced Hypotension that persists despite adequate fluid resuscitation

Question 20

Should Broad Spectrum Abx be given ASAP in septic shock?

Answer 20

EBM supports prompt administration of Abx for septic

shock

*Blood Cx will be positive in only 50% of cases of septic shock

Question 21

What is the vasopressor of choice for septic shock?

Answer 21

NE is first line choice

Epi can be added to NE or substituted

Dopamine only substituted if bradycardic

Phenylephrine NOT recommended unless NE causes arrhythmias or continue to have high CO and low TPR

Dobutamine sued if inotropic agent needed

Question 22

Should corticosteroids be used in septic shock?

Answer 22

low dose corticosteroid use improve shock reversal

(no benefit in sepsis in the absence of shock)