Clinical Medicine IV: Shock Fundamentals

Comprehensive flashcards covering parts of the shock lecture, including pathophysiology, cardinal signs, diagnostics, and management of distributive, hypovolemic, obstructive, and cardiogenic shock.

What is the clinical definition of shock?

A life-threatening condition of circulatory failure causing inadequate oxygen delivery to meet cellular and metabolic needs and oxygen consumption requirements.

According to the transcript, what mortality rate is associated with a lactate level greater than $4\,mmol/L$?

A mortality rate of $30\%$, which represents a 5x higher risk of death.

What is the formula used to estimate Mean Arterial Pressure (MAP)?

$$\text{MAP} = \text{diastolic} + \frac{1}{3}(\text{systolic} - \text{diastolic})$$

What minimum Mean Arterial Pressure (MAP) is necessary to maintain vital organ perfusion?

$$60\,mm\,Hg$$

What are the four specific cardinal signs of arterial hypotension and systemic hypoperfusion?

Hypotension (\text{Systolic} < 90), cool/clammy/dusky skin, oliguria, and mental status changes.

Which specific heart sound is often accentuated in high-output states during shock?

The third heart sound $(S3)$.

What are the three physical causes of obstructive shock mentioned in the lecture?

Pericardial tamponade, tension pneumothorax, and pulmonary embolism.

What is the number one cause of cardiogenic shock?

Myocardial Infarction (MI).

What three criteria define septic shock specifically (distinguished from sepsis)?

Sepsis-induced hypotension unresponsive to fluids (systolic $< 100\,mm\,Hg$), serum lactate $> 2\,mmol/L$, and the requirement of vasopressors to maintain a MAP > 65\,mm\,Hg.

What are the four measurements used in the SIRS (Systemic Inflammatory Response Syndrome) criteria?

Temperature (> 38^{\circ}C or $< 36^{\circ}C$), Heart Rate ($> 90$), Tachypnea (> 20\,\text{breaths/min}), and WBC count (> 12,000/cu\,mm or $< 4,000/cu\,mm$ or $> 10\%$ bands).

What three parameters comprise the qSOFA score used in the Emergency Department?

Altered Mental Status ($\text{GCS} < 13$), Respiratory rate $> 22\,\text{breaths/min}$, and Systolic BP < 100\,mm\,Hg.

What are the characteristic vital signs and skin presentation of neurogenic shock?

Hypotension (< 90\,mm\,Hg), bradycardia (< 80\,bpm), and skin that is pink, warm, and dry due to loss of sympathetic tone.

In the general treatment of shock, what is the initial recommended bolus for IV crystalloid fluid resuscitation?

$20-30\,mL/kg$ of ideal body weight.

In anaphylactic shock, what percentage of patients experience a biphasic reaction?

$$4-5\%$$

What is the clinical utility of measuring procalcitonin levels in a shock patient?

It is released in response to bacterial infection, helps guide antibiotic effectiveness, and is particularly noted in history consistent with pneumonia.