A4 Em 2 Shock

Front 1

Which has the higher mortality, septic or cardiogenic shock?

Back 1

cardiogenic 60 -90%

(septic 35-40%)

Front 2

What is the cellular physiology of shock? (3 events)

Back 2

cell membrane ion pump dysfunction
leakage of contents into intracellular space
intracellular pH dysregulation

Front 3

Distinguish between low preload and low afterload shock

Back 3

low preload: hypovolemic, vasoconstriction
low afterload: distributive, vasodilation

Front 4

Describe the four stages of hypovolemic shock wrt blood pressure and pulse

Back 4

blood pressure:
stage 1 has normal blood pressure
stage 2 has normal BP, or elevated diastolic
Stage 3 has systolic <100
Stage 4 has systolic < 70
pulse:
stage 1: < 100
stage 2: >100
stage 3: >120
stage 4: > 140

Front 5

Describe the four stages of hypovolemic shock wrt blood loss (ml, %)

Back 5

stage 1: < 750 ml < 15%
stage 2: 750-1500 ml 15-30%
stage 3. 1500-2000 ml 30-40%
stage 4. > 2000 >40%

Front 6

Describe the four stages of hypovolemic shock wrt urine output

Back 6

stage 1: > 30 ml/hr
stage 2: 20-30
stage 3: 5-15
stage 4: negligible

Front 7

Why might heart rate might not be a reliable metric for judging shock, esp in an elderly patient?

Back 7

BBs, CCBs, digoxin, slow compensatory heart rate

Front 8

How are children special cases when evaluating shock?

Back 8

They have very strong compensatory systems, so may be much worse off than they appear from vitals. Compensation will sustain to a breaking point then drop off suddenly.

Front 9

Which classes of shock are regarded as compensated?

Back 9

class 1 and 2

Front 10

What are some causes of cardiogenic shock?

Back 10

myopathy
arrhythmia
mechanical
extracardiac / obstructive

Front 11

What happens to cardiac output in distributive shock?

Back 11

it increases mainly b/c of increased HR

Front 12

What distinguishes SIRS from sepsis?

What distinguishes sepsis from severe sepsis?

Back 12

sepsis: suspected or documented infection

severe sepsis has hypotension or hypoperfusion, or organ dysfunction

septic shock: hypotension is refractory

Front 13

Goals of early goal directed sepsis treatment

Back 13

CVP of 8
MAP > 65
SVO2 > 70% (surrogate for cardiac output)
antibiotics within one hour of site identification or empiric w/in 3 hours of ED arrival

Front 14

A change in blood pressure of more than ? is suggestive of shock

Back 14

40

Front 15

Which type of shock has warm rather than cold and clammy skin?

Back 15

early distributive shock

Front 16

workup for sepsis

Back 16

CBC, chem 7 LACTATE
to identify cause of shock:
CXR (pna, pulm edema
EKG (cardiogenic)
UA (protein - renal failure)

blood cultures

Front 17

Noninvasive alternative to CVP

Back 17

US: measure IVC as it responds dynamically to stresses

Front 18

Best measure of MAP

Back 18

arterial line -- dynamic beat to beat measure

Front 19

Norepinephrine is the first line choice of vasopressor in most cases of septic or cardiogenic shock.
What is best for neurogenic shock?

Back 19

dopamine

Front 20

What pressor is best for treating a TCA overdose?

Back 20

dobutamine

Front 21

Main two causes of shock from trauma

Back 21

hypovolemic #1
distributive from spinal/neurogenic cause #2

Front 22

Main treatment of shock

Back 22

IV access - fluids, then pressors (opt)
(to get CVP up)
if septic, antibiotics within an hour