Shock

Question 1

Presentation of Shock ?
1. SBP
2. Decr in SBP __- from baseline
3. MAP
4. HR
5. RR
6. cutaneous __
7. Oliguria (UOP< ___)
8. Altered ___
9. Decr in ___
10. Incr in __ and ___

Answer 1

1. < 90 mmHG
2. > 40 mmhg
3. < 65 mmHg
4. > 90
5. > 20 breaths per min
6. cutaneous vasoconstriction
7. 20 mL/hr
8. mental status
9. SVO2
10. Lactate and metab acidosis

Question 2

Normal Values For
1. SVO2
2. HR
3. Preload (CVP , PCWP)
4. Afterload (SVR)
5. CO?
6. CI?
7. MAP?

Answer 2

1. 65-80%
2. 60-100 bpm
3. CVP 2-6, PCWP 6-12
4. 800-1400
5. 4-7 L/min
6. 2.5-4.2
7. 65-105 mmHg

Question 3

Types of Shock : For each, state what is affected

1. Hypovolemic
2. Cardiogenic
3. Septic

What drugs would u use to treat the following parameters?

1. incr pre load
2. incr CO or CI
3. incr Afterload

Answer 3

1. decr preload , decr CO, Incr Afterload
2. decr CO
3. decr afterload or SVR
4. iv fluids
5. inotropes
6. presssors

Question 4

What treatment options for Hypovolemic Shock?
whats the fluid of choice?
What should u reserve blood for?
reserve inotropes or pressors for?

For hypovolemic shock, what would your lactate value be ?
After, begin fluid resuscitation using ?
What are some signs of HYPOperfusion ?
If hypoperfusion, what do u do?

Answer 4

Crystalloids, colloids, blood, pressors

Crystalloid

Low Hgb/Hct

Refractory shock

Lactate >=4 mmol/L
1-2 L crystalloid +/- blood
MAP < 65, SBP <90, UOP < 0.5 mL/kg/hr , Incr lactate, SVO2<65%, PCWP < 8

-Fluid boluses –> dobutamine/dopamine/norepi

Question 5

Cardiogenic Shock :
1. What happens to preload, CO, Afterload?
2. Etiologies could be? (3)
3. Which agent classes would be effective?

Answer 5

1. Preload : incr or stays same
   CO : decr
   Afterload : incr
2. Acute MI, Advanced HF, Valvular Disease
3. Inotropes/Vasodilators

Question 6

Dobutamine trends in CO, HR and SVR?

Has less Hypotension than ?
Will interact with ?

Milrinone : Trends in SVR and CO?
-50 mcg/kg bolus NOT recc in ?
-need to reduce dose in ?
-DOC with ?

Answer 6

CO : INCR
HR : Incr
SVR : Low dose decr SVR, doses 5-20 will stay same

Milrinone
-Beta blockers

SVR DECR!!! CO INCR !!!!

HF pt’s
renal insufficiency
Beta blockers

Question 7

1. Dopamine : WHat does it do to SVR and CO and HR?
   Consider for?
2. NorEPI or (Levophed)
   -SVR and CO?
   -What do u have to do before dosing NE?
3. Epinephrine
   -What happens to SVR and CO and HR at dose 0.01-0.05 ?
   -What happens to SVR, CO and HR at higher doses?
   -Whats its place in therapy?
   -Add this agent to NOREPI in ___

Answer 7

will incr both

cardiogenic shock if LOW CO and Mod-severe hypotension

2. Will greatly incr SVR, mod incr in CO or neutral
   -Fluid resus first
3. Decr SVR, INCR CO!, Incr HR
   -INCR SVR, incr CO, incr HR

-Post CT surgery or cardiogenic shock
-Septic SHock!

Question 8

Septic Shock TX : What happens to preload, CO and AFterload?
1. Early aggressive tx with ?
2. If MAP < 65 mmHg despite fluid resus, whats the first line pressor?
3. If MAP still < 65 on NE, consider adding ?
4. AFter, if Map < 65 still, consider adding ___ . If the pt has cardiac dysfunction with persistant hypoperfusion , consider adding ___

Answer 8

Preload : Decr, CO can stay same, AFterload will DECR

1. Crystalloid 30 mL/kg within 1st 3 hrs
2. NE to target MAP>= 65 mmHg
3. Vasopressin 0.03 units/min
4. EPI.
   -Dobutamine (or can do EPI as well)