Barkley Shock State AG-ACNP Review Questions and Answers

Barkley Shock State AG-ACNP Review Questions and Answers Hypovolemic shock Lab Values CO/CI= low (4) CVP=Low (3) PCWP=Low (6) SVR=High (1200) SVO2=Low (60%) cardiogenic shock Lab values CO/CI=Low (4) CVP=High (8) PCWP=High (12) SVR=High(1200) SVO2=Low (60%) septic shock lab values CO/CI=High then low (8 then 4) CVP=Low then high (3 then 8) PCWP=Low then high (6 then 12) SVR=Low (800) SVO2=low then high (60% then 80%) Anaphylactic and Neurogenic shock lab values CO/CI=low (4) CVP=Low (3) PCWP=low (6) SVR=Low (800) SVO2=low (60%) Obstructive shock lab values CO/CI=low (4) CVP=High (8) PCWP=normal/low (6-12 or 6) SVR=High (1200) SVO2=High (80%) Hypovolemic Shock Results from a loss of 20% of circulating blood volume Hypovolemic Shock Causes 1. Internal/External bleeding 2. Burns 3. DKA/HHS 4. Severe dehydration 5. Others Hypovolemic Shock Management 1. Fluid resuscitation in the mainstay of treatment 2. Vasopressin support 3. PRBC when indicated cardiogenic shock A loss of effective contractile function results in impaired cardiac output, impaired oxygen delivery and reduced tissue perfusion Cardiogenic shock causes 1. MI: Most common cause 2. Ventricular aneurysm 3. Dysrhythmia 4. Pericardial tamponade 5. Hypoxemia 6. Pulmonary edema 7. Acute valvular regurgitation 8. Acute ventricular septal defect (VSD) Cardiogenic Shock management 1. initial, careful administration of intravenous fluids 2. vasopressor support (norepinephrine, dopamine, dobutamine) Distributive shock Three forms of shock characterized by vasodilation, decreased intravascular volume, reduced peripheral vascular resistance, and loss of capillary integrity. Septic Shock Severe hypotension in spite of adequate fluid resuscitation that is caused by body's overwhelming secondary response to infection qSOFA criteria 1. Low BP (SBP 100) 2. RR 22 3. GCS 14 Septic shock management 1. Fluid resuscitation 2. Antibiotics (should be administered within 1hr) 3. Vasopressors Anaphylactic shock IgE mediated reaction that occurs shortly after exposure to an allergen Anaphylactic Shock management 1. maintain airway 2. crystalloids for volume expansion 3. diphenhydramine 25-75 mg IV or IM 4. Epinephrine 0.3 - 0.5 mg SQ or IM for respiratory distress, stridor or wheezing 5. IV glucocorticosteroids as needed 6. Consider H2 antagonist 7. Inhaled beta agonist for bronchospasm Neurogenic shock Loss of peripheral vasomotor tone as a result of spinal cord injury, regional anesthesia, etc.. Neurogenic shock Managment 1. maintain airway 2. Fluid for volume expansion 3. vasopressors Obstructive Shock Inadequate cardiac output as a result of impaired ventricular filling Obstructive shock causes 1. Massive PE: Most common 2. Tension Pneumo 3. Acute cardiac tamponade 4. Obstructed valvular disease 5. Disease of pulmonary vasculature Obstructive management 1. maintain BP while initiating tx of the underlying cause 2. Fluid administration 3. Vasopressors 4. mechanical ventilation, as indicated 5. Anticoagulation, as needed