Crawford - Ill-Appearing

Question 1

What is done in primary survey?

Answer 1

ABCDE = airway, breathing, circulation, disability, expose

Address only what’s going to kill them in the next 5 minutes?

Question 2

What is Sellick’s maneuver in airway treatment?

Answer 2

pinch cricoid cartilage to decrease gastric insufflation

Question 3

Two components of breathing that need to be assessed in primary survey?

Answer 3

oxygenation: O2 sat
ventilation: end tidal CO2

Question 4

How to optimize oxygen content in hypoxic patient?

Answer 4

• supplemental oxygen
• increase PEEP with mechanical ventilation or needle decompression
• increase hemoglobin

Question 5

What treatments can keep BP low even if circulation needs to increase?

Answer 5

beta blockers

pacemaker

Question 6

Hypotension following injury is due to _________ until proven otherwise.

Answer 6

hypovolemia

Question 7

CO = ____ x _____

Answer 7

SV x HR

Question 8

What medications will increase heart rate? (chronotropy)

Answer 8

Non-selective adrenergic agonists - epinephrine

Anticholinergics - atropine

Question 9

What medications will increase stroke volume? (inotropy)?

Answer 9

Adrenergic agonists – epinephrine, dobutamine

Question 10

What medications will increase stroke volume without increasing heart rate? (pure inotropy)

Answer 10

Digoxin

Question 11

What medications will constrict blood vessels?

Answer 11

Adrenergic agonists
Epinephrine
Norepinephrine
Vasopressin

Question 12

What medications will dilate blood vessels?

Answer 12

Nitroglycerin
Nitroprusside
Calcium channel blockers

Question 13

What is assessed in the D (disability) of the primary survey?

Answer 13

LOC: determine cause (hypoxia, cerebral injury, med/drug), GCS

Neurologically intact?: sensation and movement along dermatomes

Question 14

What is important during E (exposure) step of primary survey?

Answer 14

Keep patient warm to prevent hypothermia (trauma triad)

Question 15

Normal urine output that indicates adequate renal perfusion?

Answer 15

0.5 - 1 mL/kg/hr

Question 16

End organ signs of shock

Answer 16

Altered mental status
High HR and RR
Low urine output
Low arterial pH
Low BP (specifically MAP)

Question 17

Basic pathophysiology of shock and why it occurs

Answer 17

inadequate tissue perfusion; not enough oxygen

3 components: blood (fluid), heart (pump), blood vessels (pipes)

Question 18

“warm” vs “cold” shock

Answer 18

early/compensated shock is warm - sympathetic activation (vasoconstriction, high HR and RR)

later decompensated shock patient becomes cold/clammy and hypotensive

Question 19

Different classifications of shock

Answer 19

Distributive
Hypovolemic
Obstructive
Cardiogenic

Question 20

Causes of obstructive shock

Answer 20

Massive PE
Tension pneumothorax
Cardiac tamponade
Constrictive pericarditis

Question 21

BP = _____ x ______

Answer 21

BP = SVR x CO

Question 22

Pathophysiology of Low SVR

Answer 22

things that cause vasodilation - septic, neurogenic, and anaphylactic shock

BVs are big and leaky, so blood sits in periphery and heart overworks to compensate

Question 23

Signs of low SVR

Answer 23

WARM
pink
bounding pulses
hyper dynamic heart (fast and pounding)

Question 24

Signs of high SVR

Answer 24

Cool extremities
Pale
Poor cap refill
Thready pulses (narrow pulse pressure due to high diastolic BP)

Question 25

Stroke volume depends on what 3 factors? How do they cause shock?

Answer 25

preload = hypovolemic shock if too low afterload (aortic resistance) = obstructive shock if too high contractility = cardiogenic shock

Question 26

Management priorities in hypoperfused states

Answer 26

1) Volume: Fluids to get to CVP 10 2) BP: Vasopressors to get to MAP 60 and SBP 90 3) Flow: inotropes for improved signs of perfusion

Question 27

Why must you improve circulating volume before adding a vasopressor?

Answer 27

Vasopressors risk tachycardia and increased myocardial oxygen consumption if used too soon

Question 28

Signs of 15-35% blood loss

Answer 28

Increased HR and DBP (narrow pp), prolonged cap refill, flat neck veins

Question 29

Symptoms of cardiogenic shock

Answer 29

- Skin: cool, moist, pale with mottling - CHF signs: JVD, HJR, APE, pedal edema - Heart: murmurs, S3 or S4 - Pulse: rapid and thready/weak - Decreased BP - Decreased urine output

Question 30

Treatment of cariogenic shock

Answer 30

Increase oxygen: mechanical ventilation, reperfusion Maximize cardiac output: dysrhythmics, pacing, cardioversion, vasopressors, inotropes Decrease afterload: intra-aortic balloon pump

Question 31

Vascular changes in anaphylactic shock

Answer 31

- Diffuse vasodilation from histamine and bradykinin release | - Bronchoconstriction

Question 32

Treatment of anaphylactic shock

Answer 32

1) ABCs 2) Epinephrine 3) Steroids, H2 blockers, Albuterol, etc.

Question 33

What is septic shock?

Answer 33

multiple organ system inflammation causing hypoperfusion SIRS -> sepsis -> severe sepsis -> septic shock SIRS criteria + source of infection + hypotension

Question 34

Septic shock treatment

Answer 34

Prompt volume replacement Early antibiotic administration If MAP