AMLS Shock and Hemodynamic Instability 2 — Questions and Answers
Question 1: What is the target mean arterial pressure (MAP) in septic shock management per Surviving Sepsis guidelines?
- 65 mmHg or greater (Correct answer)
- 50 mmHg or greater
- 80 mmHg or greater
- 90 mmHg or greater
Correct answer: 65 mmHg or greater
The Surviving Sepsis Campaign recommends maintaining a MAP of 65 mmHg or greater in septic shock to ensure organ perfusion.
Question 2: Which class of hemorrhagic shock (using ATLS classification) first shows altered mental status?
- Class III (30–40% blood loss) (Correct answer)
- Class I (up to 15% blood loss)
- Class II (15–30% blood loss)
- Class IV (>40% blood loss)
Correct answer: Class III (30–40% blood loss)
Class III hemorrhage (30–40% blood volume loss) is the first class associated with altered mental status, anxiety, and confusion.
Question 3: A septic patient with a lactate of 4.2 mmol/L and hypotension despite 30 mL/kg IV fluids should receive which additional intervention?
- Initiate vasopressors (norepinephrine) (Correct answer)
- Additional 30 mL/kg fluid bolus
- Empiric antifungal therapy
- Sodium bicarbonate infusion
Correct answer: Initiate vasopressors (norepinephrine)
Persistent hypotension after adequate fluid resuscitation in septic shock requires vasopressors, with norepinephrine as first-line.
Question 4: Pulsus paradoxus greater than 10 mmHg is a classic finding in which condition?
- Cardiac tamponade (Correct answer)
- Hypertensive emergency
- Tension pneumothorax
- Aortic stenosis
Correct answer: Cardiac tamponade
Pulsus paradoxus >10 mmHg, an exaggerated fall in BP during inspiration, is a classic sign of cardiac tamponade.
Question 5: Which finding is most suggestive of obstructive shock due to massive pulmonary embolism?
- Right heart strain on ECG with hypoxia and tachycardia (Correct answer)
- Diffuse ST elevation and bradycardia
- ST elevation in inferior leads
- Peaked T waves with wide QRS
Correct answer: Right heart strain on ECG with hypoxia and tachycardia
Massive PE causes obstructive shock with right heart strain, manifested by S1Q3T3 pattern, tachycardia, and hypoxia.
Question 6: Which vasopressor is the recommended first-line agent for septic shock?
- Norepinephrine (Correct answer)
- Dopamine
- Vasopressin
- Epinephrine
Correct answer: Norepinephrine
Norepinephrine is the first-line vasopressor in septic shock due to its potent alpha effects with modest beta activity and favorable side-effect profile.
AMLS Shock and Hemodynamic Instability 2
What is the target mean arterial pressure (MAP) in septic shock management per Surviving Sepsis guidelines?