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Board Exam > Shock States > Flashcards

Shock States Flashcards

1
Q

central venous pressure

A

A measure of the pressure exerted by fluid in the right atrium
Indicative of right-sided heart failure

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2
Q

normal CVP

A

0-6 mm Hg

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3
Q

Elevated CVP

A

conditions that cause an increase in the amount of fluid in the right atrium (e.g. fluid overload, cardiogenic shock)

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4
Q

Decreased CVP

A

conditions that cause a decrease in the amount of fluid in the right atrium (e.g. dehydration, distributive shock)

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5
Q

mean arterial pressure

A

indicates the average driving force in the arterial system throughout the cardiac cycle
When available, MAP should be used in hemodynamic assessment and decision making

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6
Q

How to calculate MAP

A

MAP = [SBP + 2(DBP)]/3

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7
Q

Pulmonary arterial pressure (PAP)

A

a measure of the systolic and diastolic pressures in the pulmonary artery (15-25/5-15)

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8
Q

elevated PAP

A

caused by conditions that increase the amount of fluid in the pulmonary artery or conditions that decrease the elasticity of the pulmonary artery (e.g. hypervolemia, pulmonary hypertension)

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9
Q

decreased PAP

A

conditions that cause a decrease in the amount of fluid in the pulmonary artery (e.g. hypovolemia)

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10
Q

pulmonary capillary wedge pressure (PCWP) or Pulmonary Artery Occlusion Pressure (PAOP)

A

measure of the pressure in the left ventricle at end-diastole (maximal stretch)
indicative of left-sided heart function

Reflection of the tendency to develop pulmonary edema
Should be kept at the lowest point at which cardiac performance is acceptable to optimize cardiac performance and minimize tendency for pulmonary edema

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11
Q

normal PCWP

A

6-12 mm Hg

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12
Q

increased PCWP

A

conditions that increase the pressure in the left ventricle at end-diastole (e.g. increased fluid, decreased elasticity of the ventricle)

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13
Q

decreased PCWP

A

conditions that decrease the pressure in the left ventricle at end-diastole (e.g. hypovolemia)

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14
Q

cardiac output

A

amount of fluid in liters per minute that the heart pumps into systemic circulation

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15
Q

How to calculate cardiac output

A

CO = HR x SV

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16
Q

normal cardiac output

A

4-8 L/min

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17
Q

increased CO

A

increased by factors that increase the heart rate or increase the amount of blood that the heart puts out with each beat (e.g. inotropic agents, excess fluid)

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18
Q

decreased CO

A

decreased by factors that decrease heart rate or decrease the amount of blood that the heart puts out with each beat (e.g. drugs that decrease contractility, hypovolemia)

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19
Q

cardiac index (CI)

A

CO/body surface area
More accurate than cardiac output because it takes body surface area into account

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20
Q

normal cardiac index

A

2.5-4 L/min

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21
Q

stroke volume

A

volume of blood pumped out of the left ventricle during each systolic contraction

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22
Q

systemic vascular resistance (SVR)

A

the resistance provided by the systemic circulation against which the left ventricle must pump blood

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23
Q

How to calculate SVR

A

SVR = (MAP - mean CVP x 80) / CO

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24
Q

normal SVR

A

800-1200 dynes/sec/cm-5

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25
Q

mixed venous o2 saturation (SVO2)

A

continuous display of mixed venous oxygen saturation by the pulmonary artery catheter
Assesses the effectiveness of peripheral oxygen delivery

26
Q

normal SVO2

A

60-80%

27
Q

low SVO2

A

implies increased tissue extraction of O2
The patient has tapped the venous reserve of O2
Needs more O2

Causes:
-decreased O2 supply (e.g. decreased CO, decreased FiO2, anemia)
-increased O2 demand (e.g. fever, shivering, increased WOB)

28
Q

high SVO2

A

implies decreased tissue extraction of O2
high return of O2 is often a most early indicator of patient status change
Not using O2 (worse than too low)

Causes
-increased O2 supply (e.g. FiO2 > need)
-decreased O2 demand (e.g. hypothermia)
-decreased effective O2 delivery and uptake by the cells (e.g. sepsis, shift of oxyhemoglobin cures to the left)

29
Q

hypovolemic shock: labs
-CO/CI
-CVP
-PCWP
-SVR
-SVO2

A

CO/CI: low
CVP: low
PCWP: low
SVR: high
SVO2: low

hypovolemic –> less pressure –> everything is low except SVR which is compensating

30
Q

cardiogenic shock: labs
-CO/CI
-CVP
-PCWP
-SVR
-SVO2

A

CO/CI: low
CVP: high
PCWP: high
SVR: high
SVO2: low

acute pump failure –> ineffective pump –> blood stays in the heart

31
Q

septic shock: labs
-CO/CI
-CVP
-PCWP
-SVR
-SVO2

A

CO/CI: high then low
CVP: low then high
PCWP: low then high
SVR: low
SVO2: low then high

severe hypotension in response to infection
Similar to the other types of distributive shock, everything is low

32
Q

anaphylactic shock: labs
-CO/CI
-CVP
-PCWP
-SVR
-SVO2

A

CO/CI: low
CVP: low
PCWP: low
SVR: low
SVO2: low

ALLergen –> ALL values are low
Similar to the other types of distributive shock, everything is low

33
Q

neurogenic shock: labs
-CO/CI
-CVP
-PCWP
-SVR
-SVO2

A

CO/CI: low
CVP: low
PCWP: low
SVR: low
SVO2: low

Similar to the other types of distributive shock, everything is low

34
Q

obstructive shock: labs
-CO/CI
-CVP
-PCWP
-SVR
-SVO2

A

CO/CI: low
CVP: high
PCWP: normal/low
SVR: high
SVO2: high

Blockage –> blood backs up into R ventricle –> R atrium (CVP high)

35
Q

hypovolemic shock

A

results from a loss of >20% of circulating blood volume

36
Q

hypovolemic shock: causes

A

internal/external bleeding
burns
DKA/HHNK
severe dehydration

37
Q

hypovolemic shock: management

A

Isotonic fluids
vasopressors (e.g. norepinephrine, dopamine) and/or dobutamine (inotropic)
PRBC if H/H low

38
Q

cardiogenic shock

A

a loss of effective contractile function results in impaired cardiac output, impaired oxygen delivery, and reduced tissue perfusion

(acute pump failure)

39
Q

cardiogenic shock: causes

A

acute MI: most common cause
ventricular aneurysm
dysrhythmia
pericardial tamponade
hypoxemia
pulmonary edema
acute valvular regurgitation
acute ventricular septal defect

40
Q

cardiogenic shock: management

A

initial, careful administration of fluids
vasopressor support (e.g. norepinephrine, dopamine) and/or dobutamine (inotropic)

41
Q

distributive shock

A

three forms of shock characterized by massive vasodilation, decreased intravascular volume, reduced peripheral vascular resistance, and loss of capillary integrity

42
Q

septic shock

A

Type of distributive shock
Severe hypotension in spite of adequate fluid resuscitation that is caused by the body’s overwhelming secondary response to infection

43
Q

Septic shock: management

A

Fluid resuscitation
Blood cultures
Antibiotics within 1 hour
vasopressors (e.g. norepinephrine, dopamine) and/or dobutamine (inotropic)

44
Q

anaphylactic shock

A

Type of distributive shock
IgE mediated reaction that occurs shortly after exposure to an allergen

45
Q

anaphylactic shock: management

A

Maintain airway
Crystalloids for volume expansion
Benadryl 25-75mg IV or IM
Epinephrine 0.3-0.5 mg SQ or IM for respiratory distress
IV glucocorticoids as needed
Consider H2 antagonist (e.g. famotidine)
inhaled beta agonist for bronchospasm (e.g. albuterol)

46
Q

neurogenic shock

A

type of distributive shock
Loss of peripheral vasomotor tone as a result of spinal cord injury, regional anesthesia, etc.

47
Q

neurogenic shock: management

A

Maintain airway
crystalloids for volume expansion
vasopressors (e.g. phenylephrine, norepinephrine)

48
Q

obstructive shock

A

inadequate cardiac output as a result of impaired ventricular filling

49
Q

obstructive shock: causes

A

massive PE: most common cause
tension pneumothorax
acute cardiac tamponade
obstructed valvular disease
disease of pulmonary vasculature

50
Q

obstructive shock: management

A

Maintain BP while treating underlying cause
fluid administration
vasopressors (e.g. norepinephrine)
mechanical ventilation as indicated
anticoagulation as indicated

51
Q

toxic shock syndrome: pathogen

A

staphylococcus aureus

52
Q

toxic shock syndrome: management

A

aggressive IV fluid hydration
fever control
empiric treatment with clindamycin and vancomycin
pressor support if needed
remove tampon

53
Q

qSOFA criteria

A

1 point for each criteria; 2+ points near the onset of infection is associated with greater risk of death or prolonged ICU stay.

  1. low BP (SBP <100 mm Hg)
  2. high RR (>22)
  3. altered mentation (GCS <15)
54
Q

cardiogenic shock: S/Sx

A

tachypnea, severe SOB
tachycardia, weak pulse
hypotension

LOC
diaphoresis
pallor
cold hands or feet
oliguria, anuria

55
Q

hypovolemic shock: S/Sx

A

tachypnea
hypothermia
hypotension
tachycardia

confusion, anxiety, LOC
diaphoresis
cool skin
weakness

56
Q

septic shock: S/Sx

A

tachycardia
hypothermia or fever
tachypnea, SOB
hypotension

shaking, chills
warm, clammy, or sweaty skin
confusion
lightheadedness
oliguria, anuria
palpitations
rash

57
Q

anaphylactic shock: S/Sx

A

hypotension
tachycardia, weak pulse

wheezing, constriction of airways
urticaria, pruritis
flushed or pale skin
N/V/D
dizziness, LOC

58
Q

neurogenic shock: S/Sx

A

hypotension
bradycardia

flushed, warm skin that gets cold and clammy later
circumoral cyanosis
LOC

59
Q

obstructive shock: S/Sx

A

tachypnea
hypotension
tachycardia

Altered LOC
oliguria
cool, clammy skin
subcutaneous emphysema
chest, abdominal pain

60
Q

refractory shock: criteria, management

A

SBP <90 for more than one hour following adequate fluid resuscitation and vasopressors

IV glucocorticoids are not routinely used as part of initial therapy and should be used on a case-by-case basis
-preferred medication: hydrocortisone alone

Board Exam (18 decks)

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