ICU management scenarios including shock, mechanical ventilation, and sepsis bundles tested on USMLE Step 2 CK.
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- What are the four main categories of shock?
- Cardiogenic, hypovolemic, distributive, and obstructive shock
- What is the hemodynamic profile of cardiogenic shock?
- Low cardiac output, high systemic vascular resistance, high pulmonary capillary wedge pressure
- What is the hemodynamic profile of hypovolemic shock?
- Low cardiac output, high systemic vascular resistance, low pulmonary capillary wedge pressure
- What is the hemodynamic profile of distributive (e.g. septic) shock?
- Normal or high cardiac output, low systemic vascular resistance, low pulmonary capillary wedge pressure
- What is the hemodynamic profile of obstructive shock?
- Low cardiac output with high systemic vascular resistance, caused by a mechanical block to cardiac filling or outflow
- Name three classic causes of obstructive shock.
- Cardiac tamponade, tension pneumothorax, and massive pulmonary embolism
- How is sepsis defined under the Sepsis-3 criteria?
- Life-threatening organ dysfunction caused by a dysregulated host response to infection, marked by an acute SOFA score increase of 2 or more points
- How is septic shock defined under the Sepsis-3 criteria?
- Sepsis with persistent hypotension requiring vasopressors to maintain adequate mean arterial pressure, plus a serum lactate above 2 mmol/L despite adequate fluid resuscitation
- The first-line vasopressor for septic shock is ____.
- norepinephrine
- Which vasopressor is typically added when septic shock is refractory to norepinephrine alone?
- Vasopressin
- Which inotrope is preferred for cardiogenic shock in a patient with an adequate blood pressure?
- Dobutamine
- How much crystalloid fluid is recommended in the first 3 hours of sepsis resuscitation?
- 30 mL/kg
- In the sepsis bundle, when should blood cultures be obtained relative to antibiotics?
- Before antibiotics are given
- Within how many hours of sepsis recognition should broad-spectrum antibiotics be started?
- Within 1 hour
- What sepsis bundle step should be repeated if the initial serum lactate is elevated?
- Remeasuring the lactate to assess response to resuscitation