SURG - Shock and Critical Care
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Questions and Answers

Match the type of SHOCK

Circulatory volume is depleted from blood or fluid losses = Hypovolemic Shock Inappropriate vasodilation of peripheral blood vessels from sepsis, anaphylaxis, drug reactions, endocrine and neurogenic abnormalities = Distributive Shock Obstruction of the heart or great vessels; could be due to a PE or tension = Obstructive Shock Pump failure; May arise from ACS = Cardiogenic Shock

Match the following descriptors with corresponding shocks!

Myocardial dysfunction can be caused by blunt cardiac injury, cardiac tamponade, air embolus, myocardial infarction, mechanical abnormality = Cardiogenic Shock Hx of trauma, central venous line or cardiothoracic procedures may raise concern for tension or tamponade physiology = Obstructive Shock Sepsis leading to organ dysfunction = Distributive Shock Bleeding, excessive vomiting or diarrhea, malabsorption, or hormone imbalances such as DI can result in excessive volume loss = Hypovolemic Shock

Cardiac Tamponade (hypotension, JVD, and muffled heart sounds) is associated with which form of shock?

  • Obstructive (correct)
  • Cardiogenic
  • Distributive
  • Hypovolemic

    • What can be used to work up trauma by scanning for internal bleeding in abdominal quadrants?

    <p>FAST scan</p> Signup and view all the answers

    The abnormality of the circulatory system that results in inadequate organ perfusion and tissue oxygenation defines:

    <p>Shock</p> Signup and view all the answers

    Match the basic management with the type of shock

    <p>Needle decompression/Pericardiocentesis = Obstructive Shock Revascularization = Cardiogenic Shock surgical intervention or angioembolization = Hypovolemic Shock - Hemorrhagic Quick use of antibiotics, IVF, vasopressors, mechanical ventilation = Distributive Shock - Sepsis</p> Signup and view all the answers

    Most common cause of distributive shock

    <p>sepsis</p> Signup and view all the answers

    Match the categories of Distributive Shock - Inappropriate vasodilation of peripheral blood vessels

    <p>response to infx leads to hypotension requiring vasopressors to maintain MAP &gt;65 (despite adequate fluid resuscitation) with concomitant lactic acidosis (&gt;2) = Septic shock systemic host response to infection leading to organ dysfunction = Severe sepsis systemic inflammatory response syndrome that is induced by infectious or non-infectious insult = SIRS progressive organ dysfunction in acutely ill patient, at severe end of severity of illness spectrum of both infectious (septic) shock and non-infectious conditions = MODS</p> Signup and view all the answers

    What score is used to determine mortality for a patient in septic shock using a variety of factors?

    <p>SOFA Score</p> Signup and view all the answers

    Massive systemic vasodilation leading to cardiovascular collapse, facial and tongue swelling leading to airway compromise, bronchospasm, is known as:

    <p>Distributive Anaphylactic Shock</p> Signup and view all the answers

    Injury to spinal cord at level of cervical spine or above 6th thoracic vertebra may lead to form of vasogenic shock; Brainstem INJURY

    <p>Distributive shock - Neurogenic</p> Signup and view all the answers

    Patient presents with..... What are you worried of?

    <p>hypotension without tachycardia or cutaneous vasoconstriction. They have diminished motor/sensory exam, priapism, loss of rectal tone and reflexes. = Neurogenic Shock (Distributive Shock) facial and tongue swelling leading to airway compromise, bronchospasm = Anaphylaxis Shock (Distributive Shock) Initially warm and dilated extremity perfusion, later skin mottling with hypoperfusion. Altered mental status. Abnormal CBC, systolic BP low. = Septic shock (Distributive Shock) excessive vomiting or diarrhea, hx of recent surgery, pallor, cold, tachycardia, AMS, systolic BP low = Hypovolemic Shock</p> Signup and view all the answers

    What is the most common cause of shock in trauma patients?

    <p>Hemorrhage</p> Signup and view all the answers

    Critically ill patients require multidisciplinary needs and coordination of care. This includes: Surgery/Trauma Providers, Consulting specialists, Nursing, Respiratory therapist, Pharmacist, PT/OT, Wound care Nurse, Case Management/Social Work.

    <p>True</p> Signup and view all the answers

    What is used to guide fluid resuscitation and monitor for oliguria/anuria?

    <p>Urine output (at least 0.5 cc/kg/hr)</p> Signup and view all the answers

    When is Intracranial Pressure Monitoring indicated?

    <p>With severe traumatic brain injury</p> Signup and view all the answers

    What are indications for mechanical ventilation, besides airway compromise?

    <p>ALL of the above</p> Signup and view all the answers

    What syndrome manifests itself as a disruption of alveolar-capillary membrane, overwhelming lung inflammation, non-cardiogenic pulmonary edema, hypoxemia and shunting in three phases: Exudative, Fibroproliferative, Fibrosis

    <p>Acute Respiratory Distress Syndrome (ARDS)</p> Signup and view all the answers

    Cardiac Complications in SICU. Match the complication with a preventative measure/monitoring parameter.

    <p>Myocardial Infarction = Troponin, EKG - ASA and statin used to stabilize plaque and prevent coronary occlusion Atrial fibrillation with RVR = Beta blockers such as metoprolol; correct electrolytes; cardioversion Heart Failure/Fluid Overload = Monitor vitals Refractory Shock = Vasopressors, Mechanical circulatory support</p> Signup and view all the answers

    Match the patient presentation with the common SICU infections

    <p>New or progressive lung infiltrate, fever, leukocytosis, worsening respiratory status/need for increased support = VAP Fever without localizing symptoms or signs, cellulitis or drainage from insertion site, incidentally detected bacteremia = Catheter-related infection Superficial or deep; Increased drainage or purulent drainage = Surgical Site Infection Catheter-related UTI = Can present as fever without localizing symptoms or signs, or signs of cystitis or pyelonephritis</p> Signup and view all the answers

    An advanced age ICU patient has a quick onset of disturbances in cognition, consciousness, and perception. The patient seems disoriented, showing odd behavior such as agitation. What is the likely cause?

    <p>Delirium</p> Signup and view all the answers

    Match the Ventilator Modes!

    xX matched to Xx

    <p>PRVC (Pressure-regulated volume-control) = Ventilator delivers desired tidal volumes at set rate; You set: Tidal volume, RR, PEEP, FiO2 SIMV-PRVC = Allows patients to trigger breaths, more comfortable; Set minimum respiratory rate PSV = All breaths are patient initiated; Weaning mode, most comfortable (allows patient to control ventilation); You set pressure support, PEEP, FiO2 xX = Xx</p> Signup and view all the answers

    Study Notes

    Shock Types and Characteristics

    • Cardiac Tamponade is associated with Obstructive Shock, characterized by hypotension, JVD, and muffled heart sounds.
    • Inappropriate vasodilation of peripheral blood vessels is a characteristic of Distributive Shock.
    • Injury to the spinal cord at the level of the cervical spine or above the 6th thoracic vertebra can lead to Vasogenic Shock, which is a type of Distributive Shock.

    Distributive Shock Categories

    • Anaphylactic Shock: characterized by massive systemic vasodilation, leading to cardiovascular collapse, facial and tongue swelling, and bronchospasm.
    • Vasogenic Shock: caused by injury to the spinal cord at the level of the cervical spine or above the 6th thoracic vertebra.
    • Neurogenic Shock: caused by brainstem injury.
    • Septic Shock: caused by severe infection.

    Shock Management

    • Basic management of shock includes fluid resuscitation and vasopressor support.
    • Most common cause of distributive shock is septic shock.
    • Mortality in septic shock can be predicted using the SOFA score.

    Trauma and Shock

    • Most common cause of shock in trauma patients is hypovolemic shock.
    • Patient presentation with hypotension, tachycardia, and oliguria is worrisome for shock.
    • FAST (Focused Assessment with Sonography for Trauma) is used to work up trauma patients by scanning for internal bleeding in abdominal quadrants.

    Critical Care and Monitoring

    • Critically ill patients require multidisciplinary care, including surgery, consulting specialists, nursing, respiratory therapy, pharmacy, PT/OT, wound care, and case management/social work.
    • Urine output is used to guide fluid resuscitation and monitor for oliguria/anuria.
    • Intracranial Pressure Monitoring is indicated in patients with severe head injury or stroke.

    Respiratory and Ventilatory Support

    • Mechanical ventilation is indicated for patients with airway compromise, respiratory failure, or cardiac arrest.
    • Acute Respiratory Distress Syndrome (ARDS) is a syndrome that manifests as a disruption of the alveolar-capillary membrane, leading to non-cardiogenic pulmonary edema, hypoxemia, and shunting in three phases: Exudative, Fibroproliferative, and Fibrosis.

    Cardiac Complications and Infections

    • Cardiac complications in SICU include atrial fibrillation, ventricular tachycardia, and cardiogenic shock.
    • Preventative measures for cardiac complications include monitoring for electrolyte imbalances, hypoxia, and acid-base disorders.
    • Common SICU infections include pneumonia, urinary tract infections, and central line-associated bloodstream infections.

    Neurological and Ventilator Modes

    • Delirium is a likely cause of disturbances in cognition, consciousness, and perception in advanced age ICU patients.
    • Ventilator modes include Assist-Control, Synchronized Intermittent Mandatory Ventilation, Pressure Support Ventilation, and Continuous Positive Airway Pressure.

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