Exam 3, Shock Flashcards Preview

Year 2 CV > Exam 3, Shock > Flashcards

Flashcards in Exam 3, Shock Deck (47):
1

what is body position for shock

keep warm and comfortalbe
turn victim head on one side if neck injury not suspected.
put on back with legs raised

2

what is general definition of shock

arterial blood flow is inadequate to meet needs for O2

3

Tissue perfusion depends on what

CO and SVR

4

What are types of shock

hypovolemic
cardiogenic
distributive

5

what is hypovolemic shock caused by

hemorrhage
fluid loss
poor intake

6

how are CO and SVR affected in hypovolemic shock

decreased CO and increased SVR

7

What are causes of cardiogenic shock

cardiomyopathies, arrhythmias
mechanical
extracardiac/obstruction

8

how are CO and SVR affected in cardiogenic shock

decreased CO and increased SVR

9

how is pulmonary capillary wedge pressure affected in hypovolemic and cardiogenic shock

increased

10

what can cause distributive shock

sepsis, TSS, anaphylaxis, toxin reactions, spinal cord injury, myxedema or adrenal crisis

11

how come individuals with distributive shock have a normal or high central venous O2 sat level

resdistribution of flow to skin

12

how is CO and SVR and PCWP affected in distributive shock

increased CO
decreased SVR
decreased PCWP

13

what are markers of clinical shock

SBP 1.0 mmol/L

14

alcoholic patient with cirrhosis and ascites presents with vomiting, dry mucous membranes, clammy skin, oliguria, mental status change, BP 70/50
what type of shock?

hypovolemic

15

how is CVP levels in hypovolemic shock

decreased

16

What is Tx for hypovolemic shock

fluid replacement
0.9% saline, 1-2 L wide open
PRBCs
goal is to obtain CVP 8-12 mmHg

17

diabetic patient with dyspnea and BP 65/50
Hx + for MI
patient on loop diuretic, aldosterone antagonist, ACEI and beta blocker
HR 140
cool clammy skin
patient resltess
b/l basilar crackles and neck veins are distended
type of shock?

cardiogenic

18

describe CO, PWCP, afterload levels in cardiogenic shock

low CO, increased PWCP and increased afterload

19

what is normal Cardiac index

<2.2L/min/meters squared

20

What is Tx for cardiogenic shock

upright O2, NIPPV
low BP- dobutamine
normal or high BP- IV NTG or nitroprusside with IV loop diuretic
AF- esmolol or cardioversion
Post MI- antiplatelets, norepi or dopamine
IABP, CABG, PCI

21

distant heart sounds with clear lungs, neck veins distended, BP 60/40
EKG shows electrical alterans
most likely?

pericardial tamponade

22

What is Becks triad and what does it suggest

distended neck veins
distant heart sounds
distressed BP

cardiac tamponade

23

TEE shows free space anterior and posterior to ventricular wall,
represents what type of shock?

obstructive

24

what are causes of obstructive cough

tension pneumothorax, pericardial disease, disease of pulmonary circulation, cardiac tumor, left atrial mural thrombus, obstructive valvular disease

25

HIV patient with cough, fever, HR 98, RespR 26, WBC 9,000 with 15% bands.
glucose 145
patient most likely has?

SIRS
systemic immune response syndrome

26

what is SIRS

dysregulated inflammation related to autoimmune disorders, pancreatitis, vasculitis, VTE, burns, surgery

27

What are the labs in SIRS, sepsis or distributive shock

CMP, ABGs
type and crossmatch
coagulation parameters
lactate
blood cultures

28

what is usual acid base imbalance in SIRS

respiratory alkalosis

29

What process is related to PAMPs

septic shock

30

what is general criteria for sepsis/SIRS

infection plus TPR changes like high or low temp, HR>90 RR>20
Glucose >140
altered mentation
edema >20

31

what are the inflammatory variables of sepsis

WBC>12,000 with bandemia >10%
WBC<4,000
Increased CRP and procalcitonin (increased CD 64)

32

what are the hemodynamic variables of sepsis

SBP <60-65

33

what are the organ dysfunction variables of sepsis

PaO2/FiO22 mg/dL
INR or PTT changes
Ileus
platelets <100,000
bilirubin
hyperprolactinemia
decreased capillary refill

34

severe sepsis can be diagnosed with significatn dysfunction in how many organs?

1

35

What are the most common lab results that are evident of severeorgan dysfunction

ARDS ARF, DIC or serum lactate >4mmol/L

36

septic shock can be diagnosed whtn unable to maintain MAP >60mmHg after what?

fluid resuscitation

37

What types of shock and syndrome are characterized by a SVR<800 dynes.s/cm

distributive shock, septic shock
anyphlyaxis and adrenal insufficiency?

38

what are the 9 steps to done within 2 hours for patients with infection, SIRS and dysfunction of one organ

serum lactate
two sets of blood cultures
two 18 gauge lines
start antibiotics
give 2 L NS
CBC and BMP
O2 sat>90%
norepi is shock is present
transfer for lactate >4mmol/L, Systolic BP <60 after 2 L NS

39

What CVP do you wnat to maintain in septic shock

8-12 mm

40

how much fluids do you give early on in shcok

5 L in first 6 hours

41

What cardiac index needs to be maintained during septic shock

2-4 L/minsquared

42

What vasopressor is originall used in septic shock

norepi

43

what vasopressor is used for warm shock

phenylephrine

44

what vasopressor is used for anaphlyactic shock

epinephrine

45

what central venous O2 sat is maintained early on in septic shock

>70%

46

If central venous O2 in septic shock is <70% what do you give

PRBCs
if still <70% then dobutamine

47

if septic shock is due to adrenal insufficiency what might you use to Tx

hydrocortisone 50 mg q 6 hours