Shock

Question 1

Cardiogenic shock with RV failure

HR?

MAP?

CVP?

PAOP?

SVR?

Answer 1

HR UP

MAP up/down

CVP up

PAOP normal

SVR up

Question 1

in hemorrhagic shock, buffering may lead to

Answer 1

decreased O2 release in tissues

Question 2

loss of % of myocardial tissue leads to cardiogenic shock

Answer 2

40%

Question 2

catecholamine release in cardiogenic shock

Answer 2

compesnatory catecholamine release > reduced kidney perfuison > Renin angiotenisn activation

aldosterone > increased Na and H20 resorp

Question 2

secondary MODS

Answer 2

consequence of host response (eg cytokines)

inflammtory host resonse to toxins and other components of microorganism

Question 4

cardiogenic shoick with biventricular failure

HR?

MAP?

CVP?

PAOP?

SVR?

Answer 4

HR? up

MAP? up/down

CVP? up

PAOP? up

SVR? up

Question 5

therapy anaphylatic shock

Answer 5

rapid infusion of cristalloid or colloid solution

epi - B2 - brochodilation, iontrope, a-mimetic at high doses (vasoconstriction)

NE if refractive (a-mimetic)

Question 6

Hypvolemic shock
HR?

MAP?

CVP?

PAOP?

SVR?

Answer 6

HR? up

MAP? down

CVP? down

PAOP? down

SVR? up

Question 6

Sepsis: at least one of following sx of inadequate organ function:

Answer 6

altered mental state

hypoxemia

elevated plasma lactate

oliguria (urine

Question 6

Primary MODS

Answer 6

direct result of insult, early in course and directly attributable to insult

Question 8

progressive shock stage

Answer 8

failing compensation

worsening capilary leakage

metabolic acidosis

increased blood viscosity and micro sludging

organ dysfxn (MODS)

Question 9

obstructive shock

Answer 9

cardiogenic shock resulting from emchanical impedient

depressed cardiac output

(via PE, tension pneumothorax)

Question 10

metabolic derangement of cardiogenic shock

Answer 10

lactic acidosis due to systemic malperfusion > cardiac dysfunction

Question 11

septic shock treatment for

Answer 11

vassopressors for hypotension not responsive to fluid to MAP >65

If persistent arterial hypotension or lactate > 4mmolL:

–measure CVP

–Measure ventral venous O2 sat

remeasure lactate if initital lactate was elevated

Question 11

DAMPS

Answer 11

inflam mediators released in response to tissue trauma activating same pathway as bacterial products

Question 12

septic shock criteria

Answer 12

persistent arterial hypotension despite adequate fluid resuscitation or

unexplained tissue hypoperfusion

culture positive bacteremia NOT needed

Question 13

initital fluid resuscitation in septic shock

Answer 13

crystalloids (increased incidence of renal failure with hydroxyetyhl starches)

(albumin if substantial crystalloids needed)

Question 14

Cardiogenic shock with LV failure

HR?

MAP?

CVP?

PAOP?

SVR?

Answer 14

HR? up

MAP? up/down

CVP? normal

PAOP? up

SVR? up

Question 16

Early/Late disrtibitve shock

HR?

MAP?

CVP?

PAOP?

SVR?

Answer 16

HR up

MAP down

CVP down/normal > up/normal

PAOP down normal > up normal

SVR down

Question 18

organ dysfunction of shock

Answer 18

acute kidney tubular necrosis and subsequent failute

liver congestion with elevated enzymes and coagulopathy

GI ischemia, hemmorhage, peritonitis

ARDS

Question 19

cinical presentation cardiogenic shock

Answer 19

agitaion

pale, cool, ,clammy skin

RV dysfxn (PE, RCA MI) elevated venous pressure, jugular dist

LV dysfxn (LAD/Cx MI, Acute AI/MR): Pul edema

Question 20

cardiogenic shock management

Answer 20

optimize ventricular filling

improve cornary perfusion with NE, pehnylepinephrine, ionotrpoics, IABP, mechanical circulatory support

If acute MI casue, coronary angiography + immediate reperfusion

Question 21

systemic reaction to shock (6)

Answer 21

• progressive vasoconstriction

increased flow to vital organs

increase CO/CI

increase resp rate and tidal volume

reduce urine production

reduced GI activity

Question 23

criteria of SIRS (need 2)

Answer 23

Tachypnea (>20)

WBC 12000

HR > 90
Fever or hyopthermia

Question 24

neurogenic shock

Answer 24

profoudn vasodilation or art and venous blood due to brainstem injury, TBI massive BP drop and reflex Tachy

Question 25

in septic shock, for inotropic suport in case of myocardial dysfunction

Answer 25

dobutamien

Question 26

septic shock treatment,

Answer 26

measure lactate blood culture prior to antibiotics broad spectrum antibiotics cyrtalloid for hypotension or lactate

Question 26

penyhelphrine in septic shock?

Answer 26

no

Question 27

EKG of cardiogenic shock

Answer 27

normal, (unlikely due to MI)

Question 28

compensatory stage of shock

Answer 28

cytokine release hypeventilation (C02 removal) catecholamine release

Question 29

first choice vasopressor in septic shock

Answer 29

NE (epi if more constriction eneded)

Question 30

initial stage of shock

Answer 30

hypo perfusion tissue hypoxia lactic acidosis

Question 32

hemodynamics cardiogenic shock

Answer 32

Systolic bp \< 90, BP drop \>30 for 30 minutes increased LVEP (PAWP \>15) Reduced Cardiac index (

Question 33

therapy of hemorrhagic shock

Answer 33

crystalloids (colloid if mild) (PRBC is significant reduction in Hg)

Question 34

obstructive shock ## Footnote HR? MAP? CVP? PAOP? SVR?

Answer 34

HR? up MAP? down CVP? up PAOP? up SVR? down

Question 35

decpensated hemorrhagic shock

Answer 35

disturbance of macro and microcirculation (decreased perfusion) anaerobic metabolism \> lactive acidosis

Question 36

refractory shock stage

Answer 36

irreversible organ damage cell death degradation of ATP to adenosine