Shock & CV

Question 1

SNS reserve

Answer 1

Ability to ramp up activity levels. 5L/min-25L/min. Expressed as percentage above. 400%. 4 fold increase.
Elite athletes: 30-40L/min

Question 2

High Pulmonary Venous Pressure

Answer 2

Prevents fluid reabsorption at the venular end of the capillary. Fluid in lungs

Question 3

Severe Myocardial Infarct

Answer 3

1. Initially inadequate cardiac output.
2. Autonomic compensation
3. Volume retention
4. Not enough cardiac output to survive challenge.

Question 4

Heart Failure

Answer 4

1. Initially cardiac function inadequate for minimum CO.
2. After digitalis, cardiac output above minimum required.
3. Allow diuresis and decrease blood volume.

Question 5

Swan

Answer 5

Gold standard for measuring cardiac output.

Question 6

Indication dilution test

Answer 6

Faster the dilution the faster the CO

Question 7

Fick Equation

Answer 7

Measures how much oxygen delivered vs. how much blood required to carry said oxygen.
DL/min(Deciliters/min)
CO(L/min)=O2 absorbed per minute by the lungs(mL/min)/Ateriovenous O2 difference(mL/L of blood)

Question 8

SVO2

Answer 8

Saturation of Venous Hgb of Oxygen

Question 9

Arterial Blood

Answer 9

20mL O2/dL

Question 10

Venous Blood

Answer 10

15mL O2/dL

Question 11

Normal O2 Absorption(Vo2)

Answer 11

250mL O2/min

Question 12

Deciliter(DL)

Answer 12

1/10th of a liter

Question 13

Coronary Circulation Oxygen Concentration

Answer 13

High oxygen extraction rate 20-15=5mL O2/dL

Question 14

Pulse Pressure Variation

Answer 14

Affected by ventilation, predictor of fluid responsiveness. Can give 100-250mL bolus or passive leg raise.

Question 15

SBP drop during inspiration

Answer 15

less than10mmHg. If empty, could drop more than 10.

Question 16

Pulsus Paradoxus

Answer 16

Drop of more than 10mmHg

Question 17

The more ischemic..

Answer 17

The more permeable

Question 18

Steroid use in Shock

Answer 18

Help stabilize cell wall and reduce permeability

Question 19

Shock Treatment

Answer 19

Pressor, Inotrope, steroid, fluids, colloids, positioning, oxygen

Question 20

Carotid Bifurcation

Question 21

3 important nerves

Question 22

Medulla

Answer 22

Lower part of brain stem

Question 23

CV System Reflexes

Answer 23

Epi/Norepi, SVR, Contractility, HR, Vasopressin, RAAS, ANF/ANP reduction, renal fluid retention, blood shifts(spleen), thirst, CNS ischemic response

Question 24

CNS Ischemic Response

Answer 24

Strongest CV reflex in the body. Tells all blood vessel to constrict. Can increase BP to over 200 even in low blood volume states. Oscillations

Question 25

Pcap

Answer 25

30-10mmHg

Question 26

Pisf

Answer 26

-3mmHg

Question 27

Conditions with no reserve

Answer 27

1. Severe coronary thrombosis 2. Severe valvular disease

Question 28

1. Normal reserve 2. Athlete Reserve 3. Mild valvular disease 4. Moderate CAD, Diphtheria

Answer 28

1. 400% 2. 600% 3. 300% 4. 150%

Question 29

Drug reserved for the end of Heart Failure

Answer 29

Digitalis

Question 30

Parameters used to assess Shock

Answer 30

1. CO 2. SVR 3. CVP 4. Blood Gas-PH 5. Swan 6. Flow track 7. Venous Blood gas 8. Lactate 9. Coags

Question 31

Retrograde perfusion

Answer 31

Backwards blood flow toward the aortic valve as it closes, this in turn feeds the coronary arteries.

Question 32

Impedance Changes

Answer 32

More blood flowing, lot of iron in Hgb, this will mess with electromagnetic field

Question 33

Echocardiogram

Answer 33

Use to estimate Stroke volume then multiply by HR to estimate CO.

Question 34

Lysosomes

Answer 34

In ischemia, they begin to dissolve parts of the endothelial cells which will create holes. This allows colloids to leave. Lose osmotic pressure. Decrease blood volume.

Question 35

Medulla

Answer 35

Lower part of Brain stem. Major controller of CV system. Contractility, SVR, HR

Question 36

Spleen

Answer 36

Source of Hgb and RBCs

Question 37

Oscillations

Answer 37

Baroreceptor mediated maintenance of BP.