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25 Cards in this Set
- Front
- Back
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Chock is low BP and hypoperfusion of vital organs
True/False |
False- NOT defined as low BP. It can be normal if SVSR is elevated
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Hypertensive crisis can even cause shock due to end organ damage
True/False |
True - example eclampsia (hypertensive condition in pregnancy_
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Shock is all about _______. If it is decreased, it leads to _______ metabolism which produces lactic acid (marker)
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oxygen
anaerobic |
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Shock encompasses a progression from SIRS to MOD. What do these stand for?
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Systemic infammatory response syndrome
Multi-organ dysfunction |
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Classic clinical findings in shock:
Hypotension (systolic <__mmHg) Cool, clammy skin Altered _____ ______ Urine output < __cc/hr Metabolic acidosis |
90
mental status 20 |
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What is the equation for shock index?
Normal 0.5-0.7 >1 increased _______ |
HR/Systolic pressure
mortality |
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What do you measure with a Swan Ganz catheter? Although it is associated with increased mortality
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Capillary wedge pressure (left ventricular pressure)
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What kind of shock?
Acute MI Arrhythmia Out-flow obstruction (aortic stenosis, IHSS, VSD, mitral regurgitation) |
Cardiogenic (heart fails)
Decreased CO due to pathology in the heart |
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Which category of shock?
Decreased systemic vascular resistance Septic shock Vasodilation/constriction |
Distributive (increased area for blood to disperse to)
Initially CO is increased then it falls |
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What type of shock can appear flushed rather than pale/clammy
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Vasodilation - DVR decrased overall due to something like a spinal cord injury
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What type of shock?
Pulmonary emoboli Pericardial tamponade Constrictive pericarditis |
Extracardiac (outflow obstruction)
Causes of decreased CO due to external pathology |
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What type of shock?
Diarrhea, vomiting, diuretics, sweating Hemorrhage Burns 3rd spacing: ascites |
Hypovolemic (lack of fluid)
Caues of decreased CO due to decreased preload |
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Tx of Shock:
Primary principle? Vasopressor agents - like what? Possibly antibiotics, surgery, thrombolytics, anticoagulants |
Volume replacement! Normal saline, blood
Dopamine, Epi, NE, dobutamine |
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True/False
Use of the Trenelenburg positioning is beneficial in patients with clinical shock |
False - some evidence shows it might be harmful
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True/False
There is no difference in efficacy or safety between epi, or NE/dobutamine tx for shock |
True
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True/False
Hematocrit numbers will fall higher than Hemoglobin numbers |
False - they are the same
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True/False
Hypothermic therapy helps comatose pts after resuscitation |
True - improved neuro performance at the time of discharge
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True/False
Hypertonic saline is better than normal saline for resuscitation fluids |
False - Normal saline works for any problem initially
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True/False
Intesnive insulin therapy in patients with severe sepsis can provide some benefit |
FALSE - can actually harm
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18 year old collapsed during the 19th mile of marathon.
BP 75/30 Pulse 144 R 26 What's the cause? |
Hypovolemic shock (presents as a volume depletion)
Give fluids |
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60 year old 3 days post-op from laparoscopic cholecystectomy. Pale, arouses to pain only.
+ JVD BP 60/0 P - 120, R 27 What is the cause? |
Most likely Extracardiac shock
Increased central venous pressure from pulmonary embolism Give TPA |
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Substernal pressure, clutching chest, pale, diaphoretic, mottled skin, wet crackles, S3
BP 70/36 P 145, R 26 What is the cause? |
Cardiogenic shock
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74 year old female, 4 day hx of back ache and fever. Flushed skin, warm
CV rapid, no JVD, clear lungs, no edema BP 80/40 P 145, R 24 What's the cause? |
Distributive shock (shunting problem)
Vasodilated - maybe fluids/pressure agent |
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25 year old launched off snowmobile. neck pain, numbness in legs, arms, chest pain
BP 60/0 P 160, R 30 Most likely cause? |
Hypovolemic shock - trauma, bleeding
Give fluids Look for tamponade or pericarditis - but first assume hypovolemic |
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30 year old with diabetes, fever, vomiting, nausea, no insulin for 3 days.
cool, poor turgor, mucous membranes dry BP 90/70 P120, R28, T 100F Most likely cause? |
Hypovolemic - not flushed skin which would indicate septic infection
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