Case #1 Questions:

1. What are the three major categories of shock?  How might these 3 categories of shock be further separated into two physiologic patterns? Answer

2. Based upon history and physical, what is the most likely category of shock in this patient? Answer

3. In addition to identifying the treating the underlying cause, what would be your initial therapeutic intervention to treat the shock? Will your initial therapeutic intervention vary significantly based upon what category of shock is present?  What specific order would you write/give the nurse? Answer

4. What is the patient's mean arterial pressure? Answer

5. a. What are the normal values for PCWP, cardiac output (CO), SVR, PVR?
   b. What would be your guess as to this patient's PCWP and CO?
   c. How is cardiac output determined?
   d. What information is gained by measuring the PCWP?
   e. Describe situations in which the PCWP may provide misleading information.
   Answer

6. What would be indications for placement of a SG catheter?   Answer
   The following is a sample P_CWP tracing:

7. 

7. a. What is the physiologic explanation for the gradual rise and fall of the PCWP tracing
   b. At which point on the PCWP tracing should one measure the PCWP (a, b, or c)? Answer

A Swan-Ganz catheter is placed revealing: PRA = 2, RV = 20/2, PAP=18/9, PCWP = 7, CO = 5.5, MVpO2 = 40 mmHg (72% sat). PaO2 is 75 (92% sat).

8. What is the SVR? PVR? Answer

9. Now what do you think is the etiology of shock? Answer

10. How do you interpret this patient's MVpO2? Answer

11. What are the major complications of prolonged septic shock? Answer

12. If IVF administration alone were not successful, what additional pharmacological support would you recommend? Answer

13. Discuss the role, if any, for the administration of each of the following:

    a. Corticosteroids
    b. Vasopressin
    c. Activated Protein C
    Answer

14. Discuss the tempo of resuscitation of patients suffering from septic shock.  Answer

     

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