Shock Pharm DeepSeek AI Questions PDF

\*\*Q1: What are the empirical criteria for diagnosing shock according to Box 3.2?\*\* \*\*A1:\*\* Ill appearance or altered mental status; heart rate \>100 beats/min; respiratory rate \>20 breaths/min or PaCO2 \1.0 mL/kg/h = normal), mental status, lactate/base deficit trends, arterial/venous bloo...

\*\*Q1: What are the empirical criteria for diagnosing shock according to Box 3.2?\*\* \*\*A1:\*\* Ill appearance or altered mental status; heart rate \>100 beats/min; respiratory rate \>20 breaths/min or PaCO2 \1.0 mL/kg/h = normal), mental status, lactate/base deficit trends, arterial/venous blood gases, cardiac ultrasound (e.g., stroke volume variation), and dynamic indices (e.g., CVP in select patients). \*\*Q11: What are key interventions for hemorrhagic shock?\*\* \*\*A11:\*\* Control bleeding (traction, direct pressure, REBOA); judicious crystalloid (10--20 mL/kg); PRBC transfusion (5--10 mL/kg) if delayed hemorrhage control; balanced transfusions (PRBCs, FFP, platelets) in massive hemorrhage. \*\*Q12: How is cardiogenic shock managed?\*\* \*\*A12:\*\* Provide oxygen/PEEP for pulmonary edema; start vasopressors (norepinephrine) or inotropes (dobutamine); reverse causes (e.g., thrombolysis); consider intra-aortic balloon pump for refractory cases. \*\*Q13: What is the significance of jugular venous distention on physical exam?\*\* \*\*A13:\*\* Suggests cardiac failure, valvular dysfunction, pulmonary embolism, or tamponade (if muffled heart sounds are present). \*\*Q14: Why is early antibiotic administration critical in septic shock?\*\* \*\*A14:\*\* Prompt antibiotics (with source control) reduce mortality. Treatment should not await hypotension, as delayed therapy worsens outcomes. \*\*Q15: What are limitations of using urine output to assess perfusion?\*\* \*\*A15:\*\* Requires 30--60 minutes for accuracy; unreliable in preexisting renal disease; does not provide real-time data. \*\*Q16: What role does bedside ultrasound play in undifferentiated shock?\*\* \*\*A16:\*\* Identifies cardiac tamponade, pneumothorax, hemoperitoneum, aortic aneurysm, ventricular dysfunction, or hyperdynamic heart (suggesting sepsis). \*\*Q17: How does the Sepsis-3 definition differ from prior criteria?\*\* \*\*A17:\*\* Sepsis-3 removes SIRS, focusing on SOFA score ≥2 with infection. Septic shock requires vasopressors + lactate \>2 mmol/L, emphasizing organ dysfunction over inflammatory markers. \*\*Q18: When should vasopressors be administered via peripheral IV?\*\* \*\*A18:\*\* If central/IO access is unavailable, use a large-gauge (≥18g) peripheral IV in the antecubital fossa or proximal site, with additional IVs for crystalloids. \*\*Q19: What defines adequate fluid responsiveness in shock?\*\* \*\*A19:\*\* Improved vital signs, urine output, and lactate/base deficit trends. Dynamic indices (stroke volume variation \>12--15%) or passive leg raise may also guide responsiveness. \*\*Q20: Why might a hyperdynamic left ventricle on ultrasound suggest sepsis?\*\* \*\*A20:\*\* Sepsis often causes compensatory increased cardiac output, visible as hyperdynamic contraction on ultrasound, aiding differentiation from cardiogenic shock. Creating comprehensive educational questions based on the provided text will take some time. I\'ll generate 50 short answer questions followed by their answers using the information from the text. Let\'s begin: 1\. \*\*Q: What is the immediate requirement upon a patient\'s presentation in shock at the ED?\*\* A: Timely assessment and treatment, sometimes before identifying the etiology. 2\. \*\*Q: How can rapid recognition of shock be supported?\*\* A: By the presence of a worsening base deficit or lactic acidosis. 3\. \*\*Q: What are common physical signs of stress response in shock?\*\* A: Ill appearance, asthenic, pale, sweating, tachypneic, with a weak and rapid pulse. 4\. \*\*Q: How should HR, BP, and oxyhemoglobin saturation be monitored in shock?\*\* A: Continuously. 5\. \*\*Q: Why may noninvasive BP measurements be unreliable in shock?\*\* A: They can be inaccurate in severe hypotensive states. 6\. \*\*Q: What does an arterial pressure monitoring line improve?\*\* A: The ability to monitor the dynamic response to therapy. 7\. \*\*Q: What provides an excellent indicator of vital organ perfusion?\*\* A: Urine output via a Foley catheter. 8\. \*\*Q: What are concerning levels for lactate concentration and base deficit in shock?\*\* A: Lactate \>4.0 mM and base deficit more negative than −4 mEq/L. 9\. \*\*Q: What does a downward trend of serum lactate indicate in shock management?\*\* A: Adequacy of resuscitation and prognosis. 10\. \*\*Q: What might a rising lactate level indicate?\*\* A: The need for more intensive measures. 11\. \*\*Q: What historical factors should be considered in shock assessment?\*\* A: History, vital signs, and physical examination documented by prehospital providers. 12\. \*\*Q: What does jugular venous distention suggest?\*\* A: Congestive cardiac failure, severe valvular abnormality, or right ventricular strain from pulmonary embolism. 13\. \*\*Q: What does a loud, machine-like systolic murmur indicate?\*\* A: Acute rupture of a papillary muscle or interventricular septum. 14\. \*\*Q: What does the presence of melanic stool on rectal examination indicate?\*\* A: Gastrointestinal hemorrhage. 15\. \*\*Q: Which imaging and laboratory tests are useful in suspected shock cases?\*\* A: Chest radiography, electrocardiography, fingerstick glucose measurement, CBC, urinalysis, serum electrolyte levels, and kidney and liver function tests. 16\. \*\*Q: How soon should lactate level measurement be performed in suspected shock patients?\*\* A: As early as possible. 17\. \*\*Q: What can bedside ultrasound screen for in shock?\*\* A: Inadequate central venous volume, occult hemoperitoneum, abdominal aortic aneurysm, left ventricular failure, right ventricular dilation or septal bowing, cardiac tamponade, or pneumothorax/hemothorax. 18\. \*\*Q: What strongly suggests sepsis in patients with undifferentiated shock?\*\* A: Hyperdynamic left ventricular function. 19\. \*\*Q: What is a key indicator in children for assessing shock?\*\* A: Symmetry of extremity movements and appropriateness of crying. 20\. \*\*Q: What foundational approach is important in hemorrhagic shock treatment?\*\* A: Ensuring adequate ventilation and oxygenation. 21\. \*\*Q: Under what conditions should PRBCs be infused in hemorrhagic shock?\*\* A: With poor organ perfusion and anticipating a 30-minute delay to hemorrhage control. 22\. \*\*Q: What is the primary empirical treatment for cardiogenic shock related to increased work of breathing?\*\* A: Providing oxygen and positive end-expiratory pressure (PEEP) for pulmonary edema. 23\. \*\*Q: What should begin promptly in septic shock management?\*\* A: Antimicrobial therapy and potentially surgical drainage or debridement. 24\. \*\*Q: What is a sign of tissue hypoperfusion?\*\* A: Hypotension, tachycardia, low cardiac output, dusky or mottled skin, delayed capillary refill, altered mental state, low urine output, low central venous oxygen saturation, or elevated lactate level. 25\. \*\*Q: How is septic shock defined according to Sepsis-3?\*\* A: Sepsis plus hypotension requiring vasopressors after fluid loading plus lactate \>2 mmol/L. 26\. \*\*Q: What immediate step is necessary for managing inadequate peripheral or central venous access in shock?\*\* A: Establishing intraosseous (IO) access. 27\. \*\*Q: What is a practical alternative to central venous oxygen saturation for resuscitation endpoints?\*\* A: Lactate clearance. 28\. \*\*Q: According to Box 3.2, list a criterion for diagnosing shock.\*\* A: Heart rate \>100 beats/min. 29\. \*\*Q: When should isotonic crystalloid solution infusion be initiated in hemorrhagic shock?\*\* A: When there is evidence of poor organ perfusion. 30\. \*\*Q: Which components are administered in septic shock if volume restoration fails?\*\* A: Vasopressor support with norepinephrine. 31\. \*\*Q: What is the function of a triple-lumen catheter in shock management?\*\* A: Allows for safe infusion of vasopressors, fluids, and antibiotics when IV access is limited. 32\. \*\*Q: Why might a central line be favored over peripheral access in severe shock cases?\*\* A: For administering high-dose vasopressor agents. 33\. \*\*Q: What past study finding questions the use of invasive resuscitation measurements in septic shock?\*\* A: Early goal-directed therapy did not show mortality advantage over usual care. 34\. \*\*Q: What are the three common causes of shock covered in Box 3.3?\*\* A: Hemorrhagic, septic, and cardiogenic shock. 35\. \*\*Q: When should packed red blood cell infusion be considered in septic shock?\*\* A: For hemoglobin level \20 breaths/min or Paco2 \