S2: Ch1 Cv 3-4

Front 1

624. Pathophys of Septic Shock?

Back 1

a. There is a severe decrease in SVR secondary to peripheral vasodilation!!!!!
b. Extremities are often warm due to vasodilation!!
c. Cardiac output is normal or increased (due to maintenance of stroke volume and tachycardia)
d. EF is decreased secondary to a reduction in contractility.

Front 2

625. What can Septic shock be complicated by?

Back 2

a. ARDS
b. ATN
c. DIC
d. Multiple Organ failure

Front 3

626. Clinical features of septic shock?

Back 3

a. Manifestations related to cause of sepsis (e.g., pneumonia, UTI, peritonitis.
b. Signs of SIRS (Systemic inflammatory response syndrome)
c. Signs of shock (Hypotension, oliguria, lactic acidosis.
d. Pts may have a FEVER or may be HYPOTHERMIC (hypothermia is more common in the very young, elderly, debilitated, and immunocompromised.

Front 4

627. Diagnosis of Septic shock?

Back 4

ssentially a clinical dx.
b. Confirmed by positive cultures, but negative cultures are common.

Front 5

628. Tx of septic shock??

Back 5

a. IV abx (broad spectrum) at maximum dosages.
b. Surgical drainage if necessary.
c. Fluid administration to increase mean BP
d. Vasopressors may be used if hypotension persists despite aggressive IV fluid resuscitation
i. Dopamine is typically the initial agent.
ii. If dopamine does not increase the BP, NE may be given

Front 6

629. Presentation of septic shock vs. hypovolemic shock?

Back 6

a. Septic shock is associated w/peripheral vasodilation and warm sin where as hypovolemic shock is associated w/peripheral vasoconstriction.

Front 7

630. What does Neurogenic shock result from?

Back 7

a. Failure of the sympathetic nervous system to maintain adequate vascular tone (sympathetic denervation).

Front 8

631. Causes of Neurogenic shock?

Back 8

a. Spinal cord injury, severe head injury, spinal anaesthesia, pharmacologic sympathetic blockade.

Front 9

632. What is neurogenic shock characterized by?

Back 9

a. Peripheral vasodilation w/decreased SVR.

Front 10

633. Clinical features of neurogenic shock?

Back 10

a. Warm, well-perfused skin
b. Urine output low or normal
c. Bradycardia and hypotension (by tachy can occur)
d. Cardiac output normal, SVR low, PCWP low to normal

Front 11

634. Tx of Neurogenic shock?

Back 11

a. Judicious use of IV fluids as the mainstay of tx.
b. Vasoconstriction to restore venous tone, but cautiously.
c. Supine or Trendelenburg position
d. Maintain body temperature.

Front 12

635. Cardiac neoplasms?

Back 12

a. Primary tumours of heart are rare.
b. Mets from other primary tumours are more common (75% of cardiac neoplasms).
c. Sites of primary tumours include: lung, breast, skin, kidney, lymphomas, and Kaposi’s sarcoma.

Front 13

636. Atrial Myxoma features (most common primary neoplasm)?

Back 13

a. Benign gelatinous growth, usually pedunculated and usually arising form the interatrial septum in the region of the fossa ovalis.
b. Majority of myxomas are sporadic, but autosomal-dominant transmission has been noted.

Front 14

637. Risk associated w/atrial Myxoma?

Back 14

a. Although benign, can embolize, leading to metastatic disease, or can cause relative valvular dysfunction.

Front 15

638. How to atrial myxomas prototypically present?

Back 15

a. Fatigue
b. Fever
c. Syncope
d. Palpitations
e. Malaise

Front 16

639. Murmur associated w/atrial myxoma?

Back 16

a. Low-pitched diastolic murmur that changes character w/changing body positions (diastolic plop).

Front 17

640. Tx of atrial myxoma?

Back 17

a. Surgical excision.

Front 18

641. Most common cause of death in the ICU?

Back 18

a. Septic Shock.

Front 19

complete

Back 19

complete!