Shock, Sepsis, and Hemodynamic Monitoring

Question 1

3 components of qSOFA

Answer 1

• Respiratory rate 22 or more
• Systolic BP < 100
• GCS < 15

Question 2

Sepsis 3 Diagnostic Criteria of Sepsis

Answer 2

• Presence of probable or documented infection and
• Change in SOFA score of 2 or more

Question 3

Definition of sepsis induced organ dysfunction

Answer 3

• Lactate elevated
• Urine output < 0.5 ml/kg/hr x 2 hours after adequate fluids
• PF ratio < 250 without pneumonia or < 200 with pneumonia
• Creatinine > 2.0 or a rise 0.5 or more from baseline
• Bilirubin > 2
• Platelets < 100,000
• INR > 1.5

Question 4

Combination antibiotics for septic shock and respiratory failure

Answer 4

Extended spectrum beta lactam + aminoglycoside

Or

Fluoroquinolone if pseudomonas bacteremia

Question 5

Combination antibiotic regimen for septic shock from strep pneumo bacteremia

Answer 5

Beta lactam + macrolide

Question 6

Appropriate time to deescalate antibiotics from dual therapy

Answer 6

3-5 days

Question 7

Duration of therapy in sepsis is longer than 7-10 days in what 5 reasons

Answer 7

1. Slow clinical response
2. Undrainable infectious foci
3. Staph Aureus bacteremia
4. Some fungal infections
5. Immunologic deficiencies

Question 8

Various wave forms of CVP monitoring

Answer 8

A = atrial contraction

C = tricuspid valve closure

V = Atrial filling with closed tricuspid valve

Question 9

Waveforms in PA catheter

Answer 9

Question 10

Why no PA catheter if LBBB present?

Answer 10

PAC can induce RBBB which would lead to complete heart block

Question 11

Clues PAC catheter is in Zone 1 or 2 of lung

Answer 11

• PAD > PCWP
• Lots of respiratory variation
• PAC tip higher than left atrium on supine CXR

Question 12

Measured vs Derived vs Other variables derived from a PAC

Answer 12

• Measured
  
  • RA pressure
  • PA pressure
  • Wedge pressure
  • HR
  • Cardiac Output
• Derived
  
  • Cardiac index
  • SVR
  • PVR
  • Stroke volume
• Other
  
  • BSI
  • Systemic arterial pressure

Question 13

Normal RA pressure

Answer 13

0-8

Question 14

Normal RV pressure

Answer 14

15-30/2-7

Question 15

Normal PA pressure

Answer 15

15-30/9-16

Question 16

Normal Wedge pressure

Answer 16

5-12

Question 17

Normal cardiac output

Answer 17

4-8

Question 18

Normal cardiac index

Answer 18

2-4

Question 19

Diagnosis when RV and PA diastolic pressures are the same

Answer 19

Pericardial tamponade

Question 20

Requirements for accurate pulse pressure variation

Answer 20

• Sinus rhythm
• Passive respiration
• Adequate tidal volume (8-10/kg)
• Good arterial waveform

Question 21

Pulse pressure variation that predicts fluid responsiveness

Answer 21

> 12-15%

Question 22

Passive leg raise equivalent to what volume of bolus

Answer 22

200-300 mL

Question 23

Technique for passive leg raise

Answer 23

transfer from 45 degrees sitting to supine with legs raised to 45 degrees for 3 minutes

Question 24

Initial fluid choice in septic shock

Answer 24

• Crystalloids are preferred
• LR associated with decrease in AKI and RRT
• Balanced salt solutions improve survival

Question 25

Primary receptor of Norepi

Answer 25

alpha and beta-1

Question 26

Primary receptor of Neo

Answer 26

alpha

Question 27

Primary receptor in epinephrine

Answer 27

Alpha, beta 1, beta 2

Question 28

Primary receptor in dobutamine

Answer 28

Beta 1