Socks QUESTIONS

SHOCK & HEMODYNAMICS — PART 2

Question 1 — Normal Hemodynamic Values

Answer: D — PAP 24/12, PAOP 10, CVP 4
All values are within normal limits.

Normal Ranges (memorize):

• CVP (Right Atrial Pressure): 2–6 mmHg

• PAP: 20–30 / 10–15 mmHg

• PAOP (Wedge): 8–12 mmHg

• Cardiac Index: 2.5–4 L/min/m²

• SVR: 800–1200 dynes/sec/cm⁵

• SvO₂: 60–80%

Question 2 — Distributive/Anaphylactic Shock

Answer: C — BP 84/42, CVP 3, PAOP 8, CI 2.5, SVR 475, SvO₂ 52%

Key Pathophysiology:

• Histamine release → massive vasodilation

• ↑ Capillary permeability → fluid leaks out

• ↓ Venous return → ↓ preload (CVP, PAOP)

• ↓ SVR, ↓ CO, ↓ SvO₂
  🔻 All arrows point down.

Question 3 — Right Ventricular Infarction/Failure

Answer: A — PAP 26/10, PAOP 10, CVP 16

• Failing RV → backup into right atrium → ↑ CVP

• Left heart (PAOP) = normal

• PA pressures = normal

Question 4 — Cardiogenic Shock

Answer: D — Cardiac Index <2
Findings:

• ↓ CO & CI due to pump failure

• ↓ SvO₂

• ↑ SVR (compensatory vasoconstriction)

• ↓ MAP (<65 mmHg)

Question 5 — Anterior Wall MI → Cardiogenic Shock

Answer: A — BP 80/50, CO 3.8, SVR 2200

• Anterior MI → left ventricular failure

• Findings: ↓ CO, ↑ PAOP, ↑ SVR, crackles (pulmonary congestion)

Question 6 — Early (Warm) Septic Shock

Answer: D — ↑ CO, ↓ SVR

• Vasodilation + inflammatory response

• “Warm” skin, bounding pulses

• One of few shock states with ↑ CO

Question 7 — Hypovolemic Shock

Answer: C — SvO₂ 55%, PAOP 3, SVR 1500

• ↓ Preload → ↓ CVP, ↓ PAOP

• ↓ SvO₂

• ↑ SVR (vasoconstriction to maintain BP)

Question 8 — Left Ventricular Failure

Answer: A — ↑ PAOP (22), Normal CVP

• LV failure → backup → ↑ Left atrial pressure (PAOP)

• Normal right-sided pressure (CVP)

• ↑ SVR (compensation)

Question 9 — Early Septic Shock Profile

Answer: D — PAOP 5, CVP 1, SVR 600

• ↓ Preload (low CVP, PAOP)

• ↓ Afterload (low SVR)

• Due to leaky capillaries + vasodilation

Question 10 — Hypotension with CVP 1, PAOP 4, SVR 1300

Answer: B — Hypovolemic Shock → Give Fluids

• Dry patient (low preload)

• High SVR (compensation)

• Rule out others:

  • Early sepsis → high SvO₂

  • Cardiogenic → high PAOP

  • Anaphylaxis → low SVR

Question 11 — Cardiogenic Shock with Pulmonary Edema

Answer: D — Mechanical Assist Device (IABP)

• Cardiogenic shock findings: ↓ CO, ↑ PAOP, ↑ SVR, ↓ SvO₂

• Goals:

  • ↑ Pump effectiveness

  • ↓ Preload & Afterload

• IABP: ↓ Afterload, ↑ Coronary perfusion

Question 12 — Nitroprusside (Nipride)

Answer: C — ↓ Preload & ↓ Afterload

• Dilates arterial + venous sides

• Used in hypertensive crises & acute heart failure

Question 13 — Fluids, Pressors, Antibiotics

Answer: B — CVP 1, PAOP 7, SVR 400, SvO₂ 78%

• Classic Sepsis profile

  • ↓ Preload, ↓ SVR

  • ↑ SvO₂ (early sepsis = poor O₂ extraction)

Question 14 — Chronic Empyema (COPD)

Answer: A — ↑ CVP

• COPD → pulmonary hypertension → right heart strain → cor pulmonale

• Blood backs up → ↑ CVP

• Left heart (PAOP) unaffected

Question 15 — Acute Anterior MI with Pulmonary Congestion

Answer: C — Dobutamine + Vasodilators + Diuretics

• Indicates Cardiogenic Shock

• Goals:

  • ↑ Contractility (dobutamine)

  • ↓ Preload/Afterload (vasodilators, diuretics)

• Avoid: beta blockers or negative inotropes

Summary Table — Hemodynamic Patterns

Shock Type	CVP	PAOP	CO/CI	SVR	SvO₂	Notes
Hypovolemic	↓	↓	↓	↑	↓	Loss of volume
Cardiogenic	↑	↑	↓	↑	↓	Pump failure
Distributive/Anaphylactic	↓	↓	↓	↓	↓	All ↓
Septic (early)	↓	↓	↑	↓	↑	Warm phase
Septic (late)	↓	↓	↓	↑	↓	Cold phase
Obstructive (PE, tamponade)	↑	↑	↓	↑	↓	Blocked flow