22 Questions
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
What can be used to work up trauma by scanning for internal bleeding in abdominal quadrants?
FAST scan
The abnormality of the circulatory system that results in inadequate organ perfusion and tissue oxygenation defines:
Shock
Match the basic management with the type of shock
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
Most common cause of distributive shock
sepsis
Match the categories of Distributive Shock - Inappropriate vasodilation of peripheral blood vessels
response to infx leads to hypotension requiring vasopressors to maintain MAP >65 (despite adequate fluid resuscitation) with concomitant lactic acidosis (>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
What score is used to determine mortality for a patient in septic shock using a variety of factors?
SOFA Score
Massive systemic vasodilation leading to cardiovascular collapse, facial and tongue swelling leading to airway compromise, bronchospasm, is known as:
Distributive Anaphylactic Shock
Injury to spinal cord at level of cervical spine or above 6th thoracic vertebra may lead to form of vasogenic shock; Brainstem INJURY
Distributive shock - Neurogenic
Patient presents with..... What are you worried of?
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
What is the most common cause of shock in trauma patients?
Hemorrhage
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.
True
What is used to guide fluid resuscitation and monitor for oliguria/anuria?
Urine output (at least 0.5 cc/kg/hr)
When is Intracranial Pressure Monitoring indicated?
With severe traumatic brain injury
What are indications for mechanical ventilation, besides airway compromise?
ALL of the above
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
Acute Respiratory Distress Syndrome (ARDS)
Cardiac Complications in SICU. Match the complication with a preventative measure/monitoring parameter.
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
Match the patient presentation with the common SICU infections
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
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?
Delirium
Match the Ventilator Modes!
xX matched to Xx
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
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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