SHOCK CRITICAL CARE

Question 1

arterial O2 equal

Answer 1

CaO2

1.39 times hemoglobin saturation 02+ (PaO2 x0.0031)

Question 2

Central venous pressure measured where/normal value

Answer 2

right ventricular end-diastolic pressure

5-10

Question 3

left atrial pressure measured where/ normal value; What adversely affects the

Answer 3

left ventricular end-diastolic pressure
5-15
mitral valve disease

Question 4

pulmonary capillary wedge pressure measured where, normal value, what effect IT

Answer 4

rough equal left atrial pressure
5-15
height PEEP/pulmonary disease/mitral valve stenosis

Question 5

mean arterial pressure calculation

Answer 5

map equals diastolic pressure +1/3 (systolic pressure minus diastolic pressure)
80-90

Question 6

cardiac index

Answer 6

cardiac output divided by meter squared

2.5-3.5

Question 7

systemic vascular resistance

Answer 7

SVR = (MAP - CVP) x 80/CO

1000-1500 dyne

Question 8

pulmonary resistance

Answer 8

100-400 dyne

Question 9

mixed venous oxygen content

Answer 9

CVO2
75%
15 cc O2 in 100 cc

Question 10

O2 delivery

Answer 10

cardiac output times arterial arch and content x10

900-1200

Question 11

02 consumption

Answer 11

250 mL/min

Question 12

clinical determinant of preload

Answer 12

venous return (central venous pressure)

Question 13

clinical determine of afterload

Answer 13

systemic resistance

Question 14

general equation of her cardiac output

Answer 14

systemic resistance x heart rate

Question 15

lift things that cause improvement of Frank Starling curve with ventricular dysfunction

Answer 15

#1 diuretics
#2 inotrope
#3 vasodilator

Question 16

how does dopamine compared to norepinephrine

Answer 16

dopamine and baby nor epinephrine

Question 17

trade name for norepinephrine

Answer 17

levophed

Question 18

class I hemorrhagic shock

Answer 18

10% blood volume

Question 19

Class II hemorrhagic shock

Answer 19

20% blood volume
over 1000 mL
NARROW PULSE PRESSURE
TACHYCARDIA

Question 20

Class III hemorrhagic shock

Answer 20

30% blood volume

HYPOTENSION

Question 21

Class IV hemorrhagic shock

Answer 21

40% blood volume

DECREASED MENTATION

Question 22

Immediate treatment for myocardial infarction

Answer 22

Morphine
Oxygen
Aspirin/ACE inhibitor
 nitroglycerin
Angioplasty

Question 23

The reduce preload for cardiogenic shock

Answer 23

Nitroglycerin
Calcium channel blocker
Narcotic
Diuretic
Venous dilatation

Question 24

Reduce afterload cardiogenic shock

Answer 24

Nitroprusside
Antihypertensive
Diuretic
Necrotic

Question 25

Gen. mechanism dopamine: Heart rate, contractility, preload, afterload

Answer 25

heart rate increased contractility Increased preload decreased Increase/normal

Question 26

Gen. mechanism dobutamine:Heart rate, contractility, preload, afterload

Answer 26

Heart rate INCREASE Contractility INCREASE the Preload decrease Normal decrease

Question 27

general mechanism isoproterenol Heart rate, contractility, preload, afterload

Answer 27

heart rate INCREASE Contractility INCREASE Preload decrease After the decrease

Question 28

Gen. mechanism nitroprusside andHeart rate, contractility, preload, afterload

Answer 28

heart rate no change Contractility no change Preload decrease Afterload DECREASE

Question 29

Gen. mechanism nitroglycerin Heart rate, contractility, preload, afterload

Answer 29

heart rate no change Contractility no change Preload DECREASE Afterload decrease

Question 30

Intracellular changes with shock

Answer 30

increased intracellular sodium | Increase interest calcium

Question 31

how is pediatric Parkland formula modified

Answer 31

Parkland PLUS maintenance Kidney D5 and a little K. (approximately 15% above Parkland)

Question 32

rough oxygen saturation curve

Answer 32

``` PaO2 40 Saturation 70 PaO2 50 Saturation 80 PaO2 60 Saturation 90 40/50 60/70 80/90 ```

Question 33

initiating event of shock

Answer 33

cellular energy deficit | Does not equal hypoxia

Question 34

factors at initiate afferent impulse to CNS neuroendocrine responsive shock

Answer 34

``` #1 bottle circulating blood volume #2 hypoxemia #3 hypercarbia #4 acidosis #5 infection #6 temperature fluctuation #7 emotional arousal #8 hypoglycemia ```

Question 35

what arterial receptors give initial physiologic response to hypovolemic shock on arteriols

Answer 35

ACTIVATION of her adrenergic receptors arterials

Question 36

Primary affective ADH

Answer 36

Pituitary origin “vasopressin” Released from barrel receptors left atrial stretch Stimulated by: Epinephrine Angiotensin II Pain Hyperglycemia Acts on distal tibial and collecting duct INCREASES water permeability-decrease his water and sodium losses Mesenteric vasoconstriction the Increases hepatic gluconeogenesis last glycol cyst

Question 37

for cytokine signal released after major injury

Answer 37

tumor necrosis factor alpha

Question 38

Anti-inflammatory cytokine

Answer 38

interleukin-10

Question 39

weather hemodynamic changes seen with neurogenic shock

Answer 39

Increased cardiac index | Unchanged venous capacitance

Question 40

Percentage of blood line and splanchnic circulation

Answer 40

20%

Question 41

indirect estimate of oxygen debt withbasic labs value

Answer 41

base deficit

Question 42

Class I hemorrhagic shock

Answer 42

Less than15% blood volume | 700 mL

Question 43

Class II hemorrhagic shock

Answer 43

``` 15-30% blood volume 750-1500 cc Widened pulse pressure Tachycardia orthostatic Tachycardia ```

Question 44

Class III hemorrhagic shock

Answer 44

30-40% 1500-2000 cc HYPOTENSION Tachycardia to the 120s

Question 45

Class IV hemorrhagic shock

Answer 45

Greater than 40% Greater than2,000 cc Tachycardia 140s OBTUNDED

Question 46

Trauma definition of systolic hypotension

Answer 46

110

Question 47

Classify severity of base deficit

Answer 47

Mild: -3 to -5 Moderate: -6 to -9 Severe: Greater than -10

Question 48

Mortality and percentage the patient with a base deficit of -6

Answer 48

25% and trauma related

Question 49

And INR 1.5 on arrival to ICU as what percent mortality

Answer 49

30% | Transfuse FFP

Question 50

What type of shock is seen with carbon monoxide poisoning

Answer 50

Vasodilatory shock

Question 51

This common causes of vasodilatory shock

Answer 51

``` MOST common SEPTIC Pancreatitis Burns Anaphylaxis Acute adrenal insufficiency Hypotension: Hemorrhagic, cardiogenic, cardiopulmonary bypass Lactic acidosis Carbon monoxide ```

Question 52

resistant cardiogenic shock medications are wet and have what potential side effects

Answer 52

``` Phosphodiesterase inhibitors: Amrinone Milrinone Thrombocytopenia Hypotension Reserve for unresponsive ```

Question 53

Acute MI post 12 hours in cardiogenic shock best treatment

Answer 53

Angiogram stent | Do not way to stabilize patient on inotropic support

Question 54

Classic neurogenic shock findings

Answer 54

Decreased blood pressure Rate cardia Warm extremities Motor/sensory disturbance