Back to Basics
What is lactate?
The five categories of shock.
What are hypovolemic, obstructive, distributive, cardiogenic and cellular toxins?
Pressor of choice for patient's who remain in septic shock after crystalloid boluses.
What is norepinephrine?
The volume of fluid resuscitation a patient in septic shock should receive.
What is 30 mL/kg?
SIRS+ a documented or suspected infection.
2 or more of the following:
What is SIRS criteria?
Preferentially treated with blood products (RBC, FFP, platelets)
What is hemorrhagic shock?
The pressor with the most alpha adrenergic effects.
What is phenylephrine?
(alpha->beta) PNEDDI
Phenylephrine, Norepinephrine, Epinephrine, Dopamine, Dobutamine, Isoproterenol
The ratio of PRBCs:FFP:platelets given durig resuscitation associated with better hemostasis and lower death due to exsanguination by 24 hours.
What is 1:1:1?
The RUSH protocol for sonography for assessing shock
What are the pumps, the tank and the pipes?
The organ of the cell that is first effected in shock.
What is the mitochondira?
Considered the "canaries in the coal mine" as they are the first to be affected in conditions of poor tissue perfusion.
Caused by PE, cardiac tamponade, tension pneumothorax, valvular dysfunction, HOCM, among others.
What is obstructive shock?
Shock resulting from any physical obstruction that limits cardiovascular flow.
Useful pressors for patients who develop tachydysrhthymias.
What are vasopressin and phenylephrine?
The thing you reach for when patient's remain hypotensive despite 30 mL/kg fluid bolus resuscitation in septic shock.
What are pressors?
Patients with prehospital ___ have a fourfold higher in-hospital mortality rate than those without it.
What is hypotension?
The component of the outer cell membrane of gram-negative bacteria that contributes to sepsis pathophysiology.
What is Lipopolysaccharide (LPS)?
However, the leading cause of sepsis in hospitalized patients are gram positive organisms.
This type of shock includes the following:
What is distributive shock?
When used alone or with other agents, this vasopressor is associated with an increased risk of death in cardiogenic shock.
What is epinephrine?
Most current guidelines recommend administrating this only to patients receiving chronic steroid replacement and in patients with refractory shock despite adequate fluid and vasopressor support.
What is hydrocortisone?
No evidence of reduced ICU or in-hospital mortality but there is a small reduction in mortality at 28 days.
The urine output associated with shock.
What is <0.5 ml/kg/hr?
The physiological endpoint that distinguishes trivial blood loss from clinically significant hemorrhage.
What is the base deficit?
Defined as the amount of strong base that would be added to 1L of blood to normalize the pH. Normal is >-2.
Caused by ACS, cardiomyopathy, flail mitral valve, myocarditis, among others.
What is cardiogenic shock?
Defined by cardiac failure causing systemic hypoperfusion/shock. Results when >40% of the myocardium is injured.
Can be used with norepinephrine to increase cardiac output and maintain oxygen delivery in cardiogenic and septic shock.
What is dobutamine?
Can start at 2 mcg/kg/min and titrate up every 5-10 minutes to a maximum of 20 mcg/kg/min. But can cause peripheral vasodilation at beta receptors so has the potential to decrease BP.
The antidote for cyanide poisoning.
What is hydroxycobalamin?
The pediatric assessment triangle of shock
What is work of breathing, general appearance, and circulation to skin?