Case #1 Questions:

1. What are the three major categories of shock?

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

3. In addition to identifying the treating the underlying cause, what would be your initial therapeutic intervention to treat the shock? 

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

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

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

   1. 

    

    

    

    

    

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

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?

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

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

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

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

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

    a. Corticosteroids
    b. Vasopressin
    c. Activated Protein C

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