Critical Care HESI Study Notes, Exam
Questions and Verified Answers
Early Stages of Septic Shock - ✔✔-Hyperdynamic, Warm
-Pulses bounding
-Low or normal BP
-Wide pulse pressure
-Skin is warm and flushed
-Hyperpnea
-Oliguria
-Hyperthermia
-Change in mental status
-Increased cardiac output and SVO2
-Decreased PCWP, PAP, SVR
-Respiratory alkalosis with hypoxemia
-Increased PT and PTT
-Low platelets
-Increased WBC and glucose
Late Stages of Septic Shock - ✔✔-Cold, Hypodynamic
-Pulses are weak and thready
-Hypotension
-Narrow pulse pressures
-Skin is cool, pale, mottled
-Bradypnea or tachypnea
-Anuria
-Hypothermia
,-Decreased level of consciousness (coma)
-Decreased cardiac output, cardiac index, and SVO2
-Metabolic acidosis with hypoxemia
-Increased PT and PTT
-Low platelets, WBC, glucose
-Increased BUN and creatinine
-Increased serum lactate
-Increased amylase, lipase
what does cardioversion treat? - ✔✔atrial dysrhythmias
what else can cardioversion treat? - ✔✔V-tach where the patient has a pulse
whats one of the main differences between use of cardioversion and use of defibrillation? -
✔✔carioversion is used for patients who have a pulse
what is cardioversion? - ✔✔the delivery of synchronized electrical shocks to the myocardium
What about patients with A-fib or A-flutter who need cardioversion? - ✔✔the patient must be
on anticoagulant therapy for 6-8 weeks before we can do elective cardioversion on them
who is encouraged to get an ICD? - ✔✔patients who are post-cardiac arrest/sudden death
what does the ICD do? - ✔✔it delivers a shock when the patient's heart goes into v-tach or v-fib
(shockable rhythm). it's purpose is to detect life-threatening arrhythmias and defibrillate
how to deactivate an ICD - ✔✔place a magnet over it
, post op ICD complications - ✔✔dysrhythmias, bleeding, cardiac tamponade
what should patients continue to use after implantation of ICD? - ✔✔they should continue to
take their anti-dysrhythmia medications
what should ICD patients do if they experience a shock? - ✔✔they should lie down and contact
the physician immediately
what should ICD patient's carry after discharge? - ✔✔medic-alert bracelet
MODS - ✔✔progressive dysfunction of 2 or more organ systems as a result of uncontrolled
inflammatory response to severe illness or injury
which organs are most severely affected by MODS? - ✔✔lungs, kidneys, splanchnic bed, liver
there is a maldistribution (could be too much in one organ and too little in another)
what is cell damage caused by in MODS - ✔✔massive release of toxic metabolites (widespread
inflammation)
manifestations of MODS - ✔✔rapid loss of consciousness (lack of oxygenated blood to the
brain)
non-palpable pulse (decreased cardiac output or extreme vasodilation)
cold, dusky extremities (lack of O2 to the tissues)
slow and shallow breaths (lack of oxygen to diaphragm so it's not working)
Questions and Verified Answers
Early Stages of Septic Shock - ✔✔-Hyperdynamic, Warm
-Pulses bounding
-Low or normal BP
-Wide pulse pressure
-Skin is warm and flushed
-Hyperpnea
-Oliguria
-Hyperthermia
-Change in mental status
-Increased cardiac output and SVO2
-Decreased PCWP, PAP, SVR
-Respiratory alkalosis with hypoxemia
-Increased PT and PTT
-Low platelets
-Increased WBC and glucose
Late Stages of Septic Shock - ✔✔-Cold, Hypodynamic
-Pulses are weak and thready
-Hypotension
-Narrow pulse pressures
-Skin is cool, pale, mottled
-Bradypnea or tachypnea
-Anuria
-Hypothermia
,-Decreased level of consciousness (coma)
-Decreased cardiac output, cardiac index, and SVO2
-Metabolic acidosis with hypoxemia
-Increased PT and PTT
-Low platelets, WBC, glucose
-Increased BUN and creatinine
-Increased serum lactate
-Increased amylase, lipase
what does cardioversion treat? - ✔✔atrial dysrhythmias
what else can cardioversion treat? - ✔✔V-tach where the patient has a pulse
whats one of the main differences between use of cardioversion and use of defibrillation? -
✔✔carioversion is used for patients who have a pulse
what is cardioversion? - ✔✔the delivery of synchronized electrical shocks to the myocardium
What about patients with A-fib or A-flutter who need cardioversion? - ✔✔the patient must be
on anticoagulant therapy for 6-8 weeks before we can do elective cardioversion on them
who is encouraged to get an ICD? - ✔✔patients who are post-cardiac arrest/sudden death
what does the ICD do? - ✔✔it delivers a shock when the patient's heart goes into v-tach or v-fib
(shockable rhythm). it's purpose is to detect life-threatening arrhythmias and defibrillate
how to deactivate an ICD - ✔✔place a magnet over it
, post op ICD complications - ✔✔dysrhythmias, bleeding, cardiac tamponade
what should patients continue to use after implantation of ICD? - ✔✔they should continue to
take their anti-dysrhythmia medications
what should ICD patients do if they experience a shock? - ✔✔they should lie down and contact
the physician immediately
what should ICD patient's carry after discharge? - ✔✔medic-alert bracelet
MODS - ✔✔progressive dysfunction of 2 or more organ systems as a result of uncontrolled
inflammatory response to severe illness or injury
which organs are most severely affected by MODS? - ✔✔lungs, kidneys, splanchnic bed, liver
there is a maldistribution (could be too much in one organ and too little in another)
what is cell damage caused by in MODS - ✔✔massive release of toxic metabolites (widespread
inflammation)
manifestations of MODS - ✔✔rapid loss of consciousness (lack of oxygenated blood to the
brain)
non-palpable pulse (decreased cardiac output or extreme vasodilation)
cold, dusky extremities (lack of O2 to the tissues)
slow and shallow breaths (lack of oxygen to diaphragm so it's not working)
