Shock AI Questions Part 2 PDF

1\. \*\*What are the empirical criteria for diagnosing shock?\*\* \- Ill appearance or altered mental status, heart rate \>100 beats/min, respiratory rate \>20 breaths/min or Paco2 \2 mmol/L. 9\. \*\*What is the chief focus of management when dealing with cardiogenic shock?\*\* \- Ameliorate incr...

1\. \*\*What are the empirical criteria for diagnosing shock?\*\* \- Ill appearance or altered mental status, heart rate \>100 beats/min, respiratory rate \>20 breaths/min or Paco2 \2 mmol/L. 9\. \*\*What is the chief focus of management when dealing with cardiogenic shock?\*\* \- Ameliorate increased work of breathing, provide oxygen and PEEP, initiate vasopressor or inotropic support, and attempt to reverse the insult. 10\. \*\*Explain the principle of quantitative resuscitation in shock treatment.\*\* \- Resuscitating patients to predefined physiologic endpoints to ensure systemic perfusion and restore vital organ function, often within the first 6 hours. 11\. \*\*In cases where oral or IV access is not feasible in shock patients, what alternative method can be used for fluid administration?\*\* \- Intraosseous (IO) access should be established for temporary administration of fluids and medications. 12\. \*\*What is the role of lactate clearance in shock resuscitation?\*\* \- It\'s used to monitor systemic perfusion and evaluate the adequacy of resuscitation efforts, aiming for a reduction of lactate concentration by 10% to 20%. 13\. \*\*When should packed red blood cell (PRBC) infusion be initiated in hemorrhagic shock?\*\* \- Initiate PRBC infusion if there\'s evidence of poor organ perfusion and expected hemorrhage control delay or if massive hemorrhage is suspected. 14\. \*\*Identify the clinical management steps for septic shock.\*\* \- Ensure adequate oxygenation, administer crystalloids, begin antimicrobial therapy, consider surgical drainage, and start vasopressor support if necessary. 15\. \*\*What additional measures should be taken if lactate clearance is inadequate post-resuscitation?\*\* \- Further steps to improve systemic perfusion should be undertaken, such as adjusting fluid therapy or vasopressor support. \*\*Q1: What are the key empirical criteria for diagnosing shock?\*\* A1: Ill appearance/altered mental status, heart rate \>100 beats/min, respiratory rate \>20 breaths/min or PaCO2 \4 mM or base deficit \2 mmol/L. \*\*Q7: What distinguishes hemorrhagic shock from simple hemorrhage?\*\* A7: Hemorrhagic shock requires meeting ≥4 criteria from Box 3.2 (e.g., lactic acidosis, organ dysfunction). Simple hemorrhage involves normal BP, HR, respiratory rate, and base deficit. \*\*Q8: What is the first-line fluid management for septic shock?\*\* A8: Administer 30 mL/kg crystalloid, titrate based on dynamic indices, volume responsiveness, or urine output. \*\*Q9: When should intraosseous (IO) access be used in shock?\*\* A9: When peripheral or central venous access cannot be rapidly obtained. IO allows temporary administration of fluids/medications. \*\*Q10: What are the treatment priorities for cardiogenic shock?\*\* A10: Oxygen/PEEP for pulmonary edema, vasopressors/inotropes (e.g., norepinephrine, dobutamine), reversing the cause (e.g., thrombolysis), and considering intra-aortic balloon pump. \*\*Q11: Why is lactate clearance a preferred endpoint for resuscitation in sepsis?\*\* A11: It is equivalent to central venous oxygen saturation as a perfusion marker, can be measured peripherally, and a 10--20% decrease within 2 hours indicates adequate resuscitation. \*\*Q12: What variables indicate tissue hypoperfusion (Box 3.4)?\*\* A12: Hypotension, tachycardia, low cardiac output, dusky/mottled skin, delayed capillary refill, altered mental status, low urine output, low central venous oxygen saturation, elevated lactate. \*\*Q13: How does the CMS definition of severe sepsis differ from Sepsis-3?\*\* A13: CMS uses 2001 criteria: ≥2 SIRS criteria + end-organ dysfunction. Sepsis-3 removes SIRS and relies on SOFA score. \*\*Q14: What is the role of arterial lines in shock management?\*\* A14: They improve BP monitoring accuracy, especially with vasoactive medications, and allow measurement of dynamic variables (e.g., stroke volume variation). \*\*Q15: When should vasoactive medications be given via peripheral IV?\*\* A15: If central/IO access is unavailable, use a large-gauge (≥18g) peripheral catheter at the antecubital fossa or proximal site. \*\*Q16: What interventions are critical in hemorrhagic shock?\*\* A16: Immediate hemorrhage control (e.g., direct pressure, REBOA), judicious crystalloid (10--20 mL/kg), and PRBC transfusion if perfusion remains poor or hemorrhage is massive. \*\*Q17: Why is urine output a useful marker in shock?\*\* A17: It reflects vital organ perfusion. Normal output is \>1.0 mL/kg/h; \