Quiz and Flashcards on Approach to Shock PPT

Questions and Answers

Which of the following is NOT a sign of end-organ perfusion in septic shock?

Warm, flushed skin (correct)

Cool skin

Cyanosis

Decreased capillary refill

What is the minimum volume for aggressive IV fluid resuscitation to be administered in the first hour for septic shock?

40 mL/kg

20 mL/kg

10 mL/kg

30 mL/kg (correct)

Which laboratory finding is indicative of septic shock?

WBC count <12,000

INR <1.5

Platelet count >400 mg/dL

Elevated serum lactate >2 mmol/L (correct)

What should be considered when selecting empiric antibiotic therapy for septic shock?

Local prevalence and resistance patterns Signup and view all the answers

In patients suspected to have gram-negative sepsis, which treatment is recommended?

Combination therapy with at least two antimicrobials from two different classes Signup and view all the answers

Which of the following is a sign of adrenal insufficiency in septic shock?

Hyperkalemia Signup and view all the answers

Which antibiotic is indicated for treatment if MRSA is suspected?

Vancomycin 15-20 mg/kg Signup and view all the answers

A patient in septic shock has a respiratory rate of 18 breaths/min. What change would indicate the condition is worsening?

Respiratory rate increases to 25 breaths/min Signup and view all the answers

What primarily characterizes Distributive Shock?

Severe peripheral vasodilation Signup and view all the answers

Which of the following factors does NOT contribute to systemic vascular resistance?

Heart rate Signup and view all the answers

What is the 30-day mortality rate for patients with Cardiogenic Shock?

50-90% Signup and view all the answers

Which type of shock is most frequently associated with Systemic Inflammatory Response Syndrome (SIRS)?

Septic Shock Signup and view all the answers

In the pathophysiology of shock, which of the following processes is least likely to occur?

Decreased vascular permeability Signup and view all the answers

What two components determine tissue perfusion according to the mentioned formula?

Cardiac output and systemic vascular resistance Signup and view all the answers

Which of the following accurately describes a common characteristic of septic shock?

It is characterized by a robust inflammatory response. Signup and view all the answers

What condition is characterized by tissue hypoxia due to a problem with oxygen utilization?

Cardiogenic Shock Signup and view all the answers

What is the dose of epinephrine for pediatric patients experiencing anaphylaxis?

0.15 mg Signup and view all the answers

What initial intravenous fluid volume is recommended for adults in anaphylaxis management?

2 liters Signup and view all the answers

Which of the following types of cardiogenic shock is attributed to severe rhythm disturbances?

Arrhythmic cardiogenic shock Signup and view all the answers

What is the most common cause of hemorrhagic hypovolemic shock?

Blunt or penetrating trauma Signup and view all the answers

In cases of hypotension after IM epinephrine administration, what should be done next?

Start IV fluids and prepare for epinephrine infusion Signup and view all the answers

Which category of hypovolemic shock results from reduced intravascular volume due to blood loss?

Hemorrhagic hypovolemic shock Signup and view all the answers

Which of the following is NOT a cause of mechanical cardiogenic shock?

Myocarditis Signup and view all the answers

Which clinical feature is most commonly associated with shock?

Hypotension Signup and view all the answers

What type of shock is primarily associated with decreased preload rather than pump failure?

Obstructive shock Signup and view all the answers

In the management of septic shock, what is the recommended volume of IV isotonic crystalloids to administer initially?

30 mL/kg Signup and view all the answers

What is the typical first dose of methylprednisolone for anaphylaxis management?

125 mg IV Signup and view all the answers

What is the first choice of vasopressor in patients with septic shock?

Norepinephrine Signup and view all the answers

Which of the following medications helps relieve itch and hives but does not alleviate airway obstruction?

Diphenhydramine Signup and view all the answers

Which condition would most require the use of intramuscular epinephrine in an emergency situation?

Anaphylactic shock Signup and view all the answers

In hypovolemic shock, what is a recommended initial intervention regarding IV access?

Place two large-bore IVs or a central line Signup and view all the answers

What should be done if shock persists despite fluid resuscitation?

Initiate vasopressors early Signup and view all the answers

Which of the following laboratory tests is NOT typically included in the evaluation of shock?

Lipid profile Signup and view all the answers

What is the primary cause that needs to be addressed in obstructive shock?

Obstruction in circulation Signup and view all the answers

Which of the following is NOT a symptom of neurogenic shock?

High blood pressure Signup and view all the answers

What is the primary first-line treatment for anaphylaxis?

IM injection of epinephrine Signup and view all the answers

In neurogenic shock, which medication may be used to manage bradycardia?

Atropine Signup and view all the answers

Which condition is characterized by decreased vascular resistance and hypotension due to CNS injuries?

Neurogenic shock Signup and view all the answers

What is a common symptom of anaphylactic shock?

Severe hypotension Signup and view all the answers

In cases of anaphylaxis with respiratory distress, the preferred route for epinephrine administration is:

Intramuscular Signup and view all the answers

Which of the following is a significant management consideration for neurogenic shock?

Temperature control and monitoring Signup and view all the answers

Which scenario likely indicates anaphylaxis based on the provided diagnosis rules?

Acute skin reaction with decreased blood pressure Signup and view all the answers

What infusion rate of dopamine is associated with increased urinary flow during neurogenic shock?

0.5 to 2 mcg/kg per min Signup and view all the answers

Which medication is specifically noted for improving outcomes in neurogenic shock?

Methylprednisolone Signup and view all the answers

Study Notes

Shock Epidemiology

Shock is a critical, life-threatening condition and ranks as one of the top 10 causes of death in the US.
Septic shock presents a 30-day mortality rate of 40-60%, while cardiogenic shock ranges from 50-90%.
The incidence of shock is on the rise, with stable mortality rates prompting aggressive research initiatives.
Increased research and protocol usage have not led to a significant reduction in mortality rates.

Definition of Shock

Shock is characterized by cellular and tissue hypoxia stemming from decreased oxygen delivery, increased oxygen consumption, inadequate utilization of oxygen, or a combination of these factors.

Pathophysiology of Shock

Local Effects:
- Intracellular edema and cellular hypoxia disrupt cell membrane ion pump function, leading to pH dysregulation and leakage of intracellular substances.
Systemic Effects:
- Acidosis and endothelial dysfunction are prevalent, coupled with complex microcirculatory alterations that hinder regional blood flow.

Tissue Perfusion Factors

Tissue perfusion relies on two primary components:
- Blood Pressure (BP) = Cardiac Output (CO) x Systemic Vascular Resistance (SVR).
Cardiac output is calculated as CO = Heart Rate (HR) x Stroke Volume (SV), influenced by:
- Preload, myocardial contractility, and afterload (systemic vascular resistance).

Problems Leading to Shock

Inadequate oxygen perfusion is a result of issues with:
- The pump (heart dysfunction).
- The fluid (blood volume loss).
- The pipes (vascular system dysfunction).

Types of Shock

Distributive: Most common in adults, marked by severe peripheral vasodilation.
Cardiogenic: Due to heart dysfunction, can involve various mechanisms.
Hypovolemic: Results from reduced blood volume.
Obstructive: Caused by external factors affecting heart output.
Multifactorial shock may involve several types in one patient.

Distributive Shock

Characterized by significant peripheral vasodilation and includes:
- Systemic Inflammatory Response Syndrome (SIRS).
- Septic, neurogenic, anaphylactic, and drug-induced shock.
SIRS Overview:
- A robust inflammatory response triggered by major insults (infectious or noninfectious), with criteria including fever (>100.4°F) and elevated heart rate (>90 bpm).

Septic Shock Signs & Symptoms

Key indicators include arterial hypotension, tachycardia, tachypnea, and evidence of end-organ perfusion failure (e.g., warm skin, altered mental status).
Lab findings may show white blood cell counts and elevated C-reactive protein.

Management of Septic Shock

Initial assessment and stabilization involve securing airways, IV access, oxygen, aggressive fluid resuscitation, and early empirical antibiotics.
Consider patient's medical history, comorbidities, and the suspected infection site when selecting antibiotics.

Neurogenic Shock

Results from CNS injury leading to decreased vascular resistance and bradycardia.
Management focuses on spinal injury stabilization, careful fluid administration, possible atropine for bradycardia, and methylprednisolone for outcome improvement.

Anaphylactic Shock

Elicited by severe allergic reactions, management includes immediate epinephrine administration, oxygen support, and volume resuscitation.

Cardiogenic Shock

Defined by diminished cardiac pump function, types include cardiomyopathic, arrhythmic, and mechanical causes.
Management may involve ACLS protocols for rhythm disturbances, judicious IV fluid use, and inotropic support.

Hypovolemic Shock

Characterized by reduced blood volume from hemorrhage or other factors, necessitating swift volume replacement.

Obstructive Shock

Mostly due to external causes of cardiac function failure, requiring prompt identification and correction, such as in tension pneumothorax or pericardial tamponade.

General Evaluation and Management

A thorough history and physical exam are essential, with vital signs reflecting shock (e.g., hypotension, tachycardia).
Labs should include a comprehensive metabolic panel, lactic acid, and coagulation profile.
Management follows the ABCs: airway, breathing, circulation, with emphasis on fluids, vasopressors, and addressing the underlying cause.

Management Pearls

Septic Shock: Prioritize fluid resuscitation (30 mL/kg) and identify the need for vasopressors targeting a MAP of 65 mmHg.
Anaphylactic Shock: Focus on rapid IV fluid resuscitation, epinephrine administration, and supporting therapies.
Cardiogenic Shock: Initiate appropriate cardiac care measures, considering inotropes and fluid status.
Hypovolemic Shock: Rapid volume replacement is critical, ensuring large-bore IV access.
Obstructive Shock: Quick identification and treatment are vital, along with fluid management and vasopressor initiation if needed.

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Description

This quiz covers the epidemiology of shock, a dangerous condition that is among the top causes of death in the US. It highlights the high mortality rates associated with various types of shock, such as septic and cardiogenic shock, and discusses the ongoing research efforts aimed at improving outcomes. Assess your understanding of these critical concepts and the current state of shock management.

Approach to the Patient in Shock ppt