Case #1 Questions:

  1. What are the three major categories of shock?
    1. What is the primary physiologic abnormality resulting in each of the three major categories of shock?
    2. How might these 3 categories of shock be further separated into two physiologic patterns?
    3. Finally, how might you determine which type of shock is present in any given patient?
      Answers
  2. Based upon history and physical, what is the most likely category of shock in this patient?Answer
  3. In addition to identifying and treating the underlying cause, what would be your initial therapeutic intervention to treat the shock?
    1. Will your initial therapeutic intervention vary significantly based upon what category of shock is present?
    2. What specific order would you write/give the nurse?
      Answers
  4. What is the patient’s mean arterial pressure? Answer
  5. --
    1. What are the normal values for PCWP, cardiac output (CO), SVR, PVR?
    2. What would be your guess as to this patient’s PCWP and CO?
    3. How is cardiac output determined?
    4. What information is gained by measuring the PCWP?
    5. Describe situations in which the PCWP may provide misleading information.
      Answers
  6. What would be indications for placement of a SG catheter? Answer
  7. Are there other non-invasive modalities that might be used to distinguish which etiology of shock is present?

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).

  1. What is the SVR? PVR? Answer
  2. Now what do you think is the etiology of shock? Answer
  3. How do you interpret this patient’s MVpO2? Answer
  4. What are the major complications of prolonged septic shock? Answer
  5. If IVF administration alone were not successful, what additional pharmacological support would you recommend? Answer
  6. Discuss the role, if any, for the administration of each of the following:
    1. Corticosteroids
    2. Vasopressin
      Answers
  7. Discuss the tempo of resuscitation of patients suffering from septic shock as well as specific end-points for CVP, MAP, and Scv02, and/or Lactic Acid Clearance.. Answer
  8. Finally, define SIRS, Sepsis, Severe Sepsis, and Septic Shock.
    Answer

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