FCCN 2 CORRECT FINAL EXAMS QUESTIONS AND
ANSWERS SURE A+
✔✔oxygen delivery/consumption - ✔✔goal: deliver enough oxygen to tissues to meet
tissue demand
major determinants of o2 delivery are Hgb and CO
✔✔ScvO2 - ✔✔central venous oxygen saturation
✔✔SvO2 - ✔✔reflects balance between oxygen delivery and demand
normal is 60-80%
✔✔SaO2 - ✔✔oxygen saturation of hemoglobin in arterial blood, obtained through an
ABG
✔✔hypovolemic shock - ✔✔shock resulting from blood or fluid loss. dehydrated, veins
dilated, arteries clamped down. decreased CO because dry. preload will be low. SNS
and RAAS are good because they help maintain perfusion of vital organs
✔✔hypovolemic shock s/s - ✔✔cool and clamped down, tachycardic, low UOP, thirsty,
dry mucous membranes
✔✔hypovolemic shock treatment - ✔✔give fluid or blood, control any bleeding
✔✔cardiogenic shock - ✔✔shock caused by inadequate function of the heart, or pump
failure. poor contractility. SNS and RAAS are bad because they will cause an increase
in resistance and fluid retention, making the situation worse.
✔✔distributive shock s/s - ✔✔flushed, peripherally dilated, tachycardic, concentrated
urine, hypotensive, high temp
,✔✔distributive shock treatment - ✔✔fill tank first by giving fluid, then clamp down with
vasopressors, add inotrope if needed, treat infection if there is one
✔✔distributive shock - ✔✔A condition that occurs when there is widespread dilation. low
BP, low afterload, low preload. SNS and RAAS are good but cannot vasoconstrict
this includes septic shock
✔✔cardiogenic shock s/s - ✔✔cool and clamped down, mottled, crackles, peripheral
edema
✔✔cardiogenic shock treatment - ✔✔block SNS and RAAS, decrease preload in L
failure, decrease afterload by dilating arteries, increase contractility with inotropes
✔✔sepsis - ✔✔life threatening inflammatory response to infection which can lead to
tissue damage, organ failure, and death
✔✔sepsis risk factors - ✔✔critically ill, very old and very young, infection, malignancy
and cytotoxic drugs, invasive lines and procedures, chronic diseases, compromised
immune status
✔✔pathophys of sepsis - ✔✔infection, sepsis, septic shock, ischemia, death
✔✔gram negative - ✔✔-worse prognosis
-pseudomonas, klebsiella, hemophilus influenzae
-higher mortality
✔✔gram positive - ✔✔-around 50% of infections
-enterococci, strep pneumoniae, hemolytic streptococcus
-frequently hospital acquired
-lower mortality
✔✔fungemia - ✔✔fungal infection that spreads throughout the body by way of the
bloodstream
aspergillus, candida, histoplasmosis
✔✔virema - ✔✔viruses in the blood
CMV, EBV, HSV, VZV
✔✔hemodynamics of early sepsis - ✔✔hyperdynamic state characterized by decreased
PVR, vasodilation, decreased preload, decreased MAP, increased HR, decreased BP,
elevated SvO2 because they are unable to utilize oxygen
, ✔✔early sepsis s/s - ✔✔high HR, fever, tachypnea, anaerobic metabolism so lactate is
released
✔✔hemodynamics of late sepsis - ✔✔hypodynamic state, decreased cardiac output,
hypoperfusion, myocardial depression, low preload, SvO2 drops as lactic acidosis
increases and organs fail
✔✔late sepsis s/s - ✔✔temp <35, cold and clammy
✔✔septic shock - ✔✔sepsis induced hypotension persisting despite adequate fluid
resuscitation
require pressors to maintain MAP >65
lactate >4
✔✔SOFA - ✔✔Sequential Organ Failure Assessment
mortality prediction score that is based on the degree of dysfunction of 6 organ systems
✔✔qSOFA - ✔✔quick sepsis related organ failure assessment for timeliness and ease
of use.
positive if they have 2 or more of these criteria:
-resp rate >22
-altered mentation
-systolic <100
if positive, draw lactate and contact primary service
✔✔MODS - ✔✔progressive dysfunction of two or more organ systems
✔✔treatment of sepsis - ✔✔sepsis bundles focused on early goal directed therapy.
first 3 hours - CALF
first 6 hours- PAL
✔✔CALF - ✔✔Cultures
Antibiotics
Lactate
Fluid
✔✔PAL - ✔✔Pressors
Assess volume status
ANSWERS SURE A+
✔✔oxygen delivery/consumption - ✔✔goal: deliver enough oxygen to tissues to meet
tissue demand
major determinants of o2 delivery are Hgb and CO
✔✔ScvO2 - ✔✔central venous oxygen saturation
✔✔SvO2 - ✔✔reflects balance between oxygen delivery and demand
normal is 60-80%
✔✔SaO2 - ✔✔oxygen saturation of hemoglobin in arterial blood, obtained through an
ABG
✔✔hypovolemic shock - ✔✔shock resulting from blood or fluid loss. dehydrated, veins
dilated, arteries clamped down. decreased CO because dry. preload will be low. SNS
and RAAS are good because they help maintain perfusion of vital organs
✔✔hypovolemic shock s/s - ✔✔cool and clamped down, tachycardic, low UOP, thirsty,
dry mucous membranes
✔✔hypovolemic shock treatment - ✔✔give fluid or blood, control any bleeding
✔✔cardiogenic shock - ✔✔shock caused by inadequate function of the heart, or pump
failure. poor contractility. SNS and RAAS are bad because they will cause an increase
in resistance and fluid retention, making the situation worse.
✔✔distributive shock s/s - ✔✔flushed, peripherally dilated, tachycardic, concentrated
urine, hypotensive, high temp
,✔✔distributive shock treatment - ✔✔fill tank first by giving fluid, then clamp down with
vasopressors, add inotrope if needed, treat infection if there is one
✔✔distributive shock - ✔✔A condition that occurs when there is widespread dilation. low
BP, low afterload, low preload. SNS and RAAS are good but cannot vasoconstrict
this includes septic shock
✔✔cardiogenic shock s/s - ✔✔cool and clamped down, mottled, crackles, peripheral
edema
✔✔cardiogenic shock treatment - ✔✔block SNS and RAAS, decrease preload in L
failure, decrease afterload by dilating arteries, increase contractility with inotropes
✔✔sepsis - ✔✔life threatening inflammatory response to infection which can lead to
tissue damage, organ failure, and death
✔✔sepsis risk factors - ✔✔critically ill, very old and very young, infection, malignancy
and cytotoxic drugs, invasive lines and procedures, chronic diseases, compromised
immune status
✔✔pathophys of sepsis - ✔✔infection, sepsis, septic shock, ischemia, death
✔✔gram negative - ✔✔-worse prognosis
-pseudomonas, klebsiella, hemophilus influenzae
-higher mortality
✔✔gram positive - ✔✔-around 50% of infections
-enterococci, strep pneumoniae, hemolytic streptococcus
-frequently hospital acquired
-lower mortality
✔✔fungemia - ✔✔fungal infection that spreads throughout the body by way of the
bloodstream
aspergillus, candida, histoplasmosis
✔✔virema - ✔✔viruses in the blood
CMV, EBV, HSV, VZV
✔✔hemodynamics of early sepsis - ✔✔hyperdynamic state characterized by decreased
PVR, vasodilation, decreased preload, decreased MAP, increased HR, decreased BP,
elevated SvO2 because they are unable to utilize oxygen
, ✔✔early sepsis s/s - ✔✔high HR, fever, tachypnea, anaerobic metabolism so lactate is
released
✔✔hemodynamics of late sepsis - ✔✔hypodynamic state, decreased cardiac output,
hypoperfusion, myocardial depression, low preload, SvO2 drops as lactic acidosis
increases and organs fail
✔✔late sepsis s/s - ✔✔temp <35, cold and clammy
✔✔septic shock - ✔✔sepsis induced hypotension persisting despite adequate fluid
resuscitation
require pressors to maintain MAP >65
lactate >4
✔✔SOFA - ✔✔Sequential Organ Failure Assessment
mortality prediction score that is based on the degree of dysfunction of 6 organ systems
✔✔qSOFA - ✔✔quick sepsis related organ failure assessment for timeliness and ease
of use.
positive if they have 2 or more of these criteria:
-resp rate >22
-altered mentation
-systolic <100
if positive, draw lactate and contact primary service
✔✔MODS - ✔✔progressive dysfunction of two or more organ systems
✔✔treatment of sepsis - ✔✔sepsis bundles focused on early goal directed therapy.
first 3 hours - CALF
first 6 hours- PAL
✔✔CALF - ✔✔Cultures
Antibiotics
Lactate
Fluid
✔✔PAL - ✔✔Pressors
Assess volume status
