Exam 2 SHOCK

Question 1

Shock is?

Answer 1

Inadequate tissue perfusion:

Not enough O2 delivered to tissues to meet demand

Question 2

Shock results in?

Answer 2

Acidosis from anaerobic metabolism ->

hypoTN

Question 3

Direct determinants of Shock are?

Answer 3

CO
O2 saturation
Hgb levels

Question 4

What is NOT a direct determinant of Shock?

Answer 4

BP

Question 5

O2 delivery (DO2) is a direct fxn of what?

Answer 5

DO2 = CO x CaO2

CaO2 = arterial gas content

Question 6

Direct determinants of BP are?

Answer 6

CO
Preload
Peripheral vascular resistance

Question 7

What is NOT a direct determinant of BP?

Answer 7

O2 sat

Question 8

Shock presentation? (4)

Answer 8

1) Tachycard
2) Tachypnea
3) +/- hypoTN
4) Sxs of ↓ end organ perfusion:
∆ mental status
↓ urine
Lactic acidosis
Cool/mottled extremities
Thready pulse

Question 9

Methods of ↑ DO2 (supply)? (2)

Answer 9

Maximize CO:
Pre/After loads
Contractility
HR

Maximize CaO2:
Hct
Supplement O2

Question 10

Methods of ↓ VO2 (demand)? (3)

Answer 10

Treat fever
Support respiratory effort
Sedation/Pain control

Question 11

Causes of Shock: Cardiogenic? (3)

Answer 11

↓ cardio fxn
Arrhy
Obstruction

Question 12

Causes of Shock: Hypovolemic? (6)

Answer 12

Hemorrhage
Over-diuresis (DM, DI)
D/V
Dehydration
DKA
Burns

Question 13

Causes of Shock: Septic?

Answer 13

Exaggerated response to Infection

Question 14

Hypovol Shock: Compensation mechanisms?

Answer 14

GOAL is to maintain CO

Barorecept-mediated vasoconstriction:

↑ Epi/Renin/ADH ->
Tachycard
Tachypnea
Narrowed pulse pressure
↓ urine output

Question 15

Hypovol Shock from Hemorrage: Compensated/Non-Progressive is?

Body’s response?

Answer 15

< 20% loss

BP maintained w/ vasoconstriction, ↑ flow to vital organs

CO maintained w/ ↑ stroke vol, slight ↑HR

Question 16

Hypovol Shock from Hemorrage: Non-Compensated/Progressive is?

Body’s response?

Answer 16

20 - 40% loss

↓ vol = inadequate preload, too low to overcome w/ ↑ contractility and CO

SNS/Neurohormonal response inadequate to overcome w/ ↑ vasoconstriction

= acidosis, mental ∆s, ↓↓ urine output

Question 17

Hypovol Shock from Hemorrage: Profound/Irreversible is?

Body’s response?

Answer 17

> 40% loss

↓↓ or no BP
↑↑ tachy
Lethargic

Question 18

Cardiogenic Shock hypoTN BP?

Answer 18

< 90/60

Question 19

Septic Shock results in? (3)

Answer 19

Circulatory collapse
Multi organ fail
Death (>35% w/ hypoTN, 45% w/ sustained)

Question 20

Septic Shock: Body’s response

Preload?

CO?

Afterload?

BP?

Organ Perfusion?

Answer 20

Preload: ↓

CO: ↑ (opp of vol/card shock)

Afterload: ↓ (opp of vol/card shock)

BP: ↓

Organ Perfusion: ↓

Question 21

Systemic Inflamm Response Synd (SIRS) is? (4)

Answer 21

response to severe clinical insults:

1) ↑ or ↓ temp
2) HR > 90 bpm
3) Resp > 20 bpm or PaCO2 < 32 mmHg
4) WBC > 12k or < 4k or >10% band

Question 22

Sepsis definition?

Severe Sepsis definition?

Septic Shock definition?

Answer 22

Systemic response to infection PLUS ≥ 2 SIRS

Sepsis w/ organ dysfxn, hypoTN or hypoperfusion

Sepsis-induced hypoTN despite adequate resuscitation

Question 23

Sepsis General Variables? (7)

Answer 23

Fever > 100.1
Hypothermia < 96.8
HR > 90
Tachypnea
∆ mental state
Significant edema
Hyperglycemia w/o DM

Question 24

Sepsis Inflamm Variables? (4)

Answer 24

Leukocytosis > 12k
Leukopenia < 4k
N count w/ > 10% band cells
Plasma C-react Protein or Procalcitionin

Question 25

Sepsis Hemodynamic Variables? (3)

Answer 25

Arterial hypoTN w/ SBP < 90 MAP < 70 or SBP ↓ > 40

Question 26

Sepsis Organ Dysfxn Variables? (7)

Answer 26

``` Arterial hypoxemia Acute oliguria Cr ↑ Coag Ileus Thrombocytopenia Hyperbilirubinemia ```

Question 27

Sepsis Tissue Perfusion Variables? (2)

Answer 27

Lactic acidosis/Metabolic acidosis | ↓ cap refill

Question 28

Multi System Organ Failure includes: Hepatic? Renal? Pulmonary? Cardiac? Neuro? Other?

Answer 28

Hepatic: Transaminitis, ↑ bilirubin, ↓ ablumin, coag, NH4 Renal: Acute tubular necrosis, olig/anuria, uremia Pulmon: ARDS, infection Card: arrhy, myocard depression Neuro: mental status -> coma Other: coag, immune

Question 29

Hyperdynamic vs Hypodynamic Septic Shock?

Answer 29

Both: hypoTN, tachycard, tachyp Hyper: bounding pulse, warm and well perfused extremities, flushed and moist skin Hypo: thready pulse, cold and poor perfused extrem, pale and dry skin