Monday Lecture: Endpoints of Resuscitation Flashcards
Shock is defined as ________________.
a condition of dysoxia in which ATP production is insufficient to meet metabolic needs
In ___________ shock, research shows that mitchondria aren’t working.
septic
Oxygen delivery is given by this equation: ________________.
(arterial oxygen content) x (cardiac output)
Which is equal to
Hgb x SpO2 x HR x afterload x contractility x preload
Failure of afterload in the oxygen delivery equation is an example of ____________ shock.
distributive (like sepsis)
What consequences are there of excessive volume expansion?
- Pulmonary edema
- Cerebral edema
Resist the urge to give fluids without considering other etiologies of tachycardia or hypotension.
What are this lecturer’s four principles of shock treatment?
- Make sure the patient is in shock (check a lactate)
- Early intervention is better
- Frequently re-evaluate with objective goals (e.g., serial lactates and I/Os)
- Stop when the goals are achieved (e.g., the lactate is lowered, the I/Os are positive)
Review some examples of the organ-specific markers of shock.
- Neurologic: Mental status
- Pulmonary:ARDS
- Cardiac: hypotension, tachycardia, EKG changes
- Renal: oliguria, decreased FeNa
- Gi: feeding intolerance, stress ulceration, colitis
- Hepatobiliary/pancreatic: transaminitis, cholestasis, pancreatitis
The base deficit is an indication of ______________.
the amount of base (in mM) that you need to add to each L of blood to bring the pH to 7.40 at 37º and 40 mm Hg of CO2
The normal is +/- 2
The main drawback of calculating the base deficit is ______________.
it does not take into account the anion gap, and so hyperchloremic metabolic acidosis can make you think you need to add more fluids when really the fluids are the problem
Lesson: always check the anion gap.
