DrAlex_76
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In septic shock, the preload, Cardiac contractility ad After load will be
A. Dec , Dec, Dec
B. Dec , Dec , Inc
C. Dec , Inc , Dec
D. Inc , Dec , Dec,
E. Inc , Inc , Dec,
F. Dec, Inc , Inc
G. Inc, Inc , Inc
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| ngaybinhyen
Forum Guru
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very variable
1. Afterload: low as for low SVR (blood pooling) ---------------> ACDE
2. Preload: low as for low effective circulatory volume----------> AC
3. Contractility initially increased as for catecholamine but decreased eventually as for tiredness, cardiac depressant, ischemia, ect.
please correct if i'm wrong
don't laugh, DrAlex
-t.
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| DrAlex_76
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bravo,
nothing to correct whenever u post, so next time dun say correct me if i am....blah blah blah ! just kidding ...
the Q means the acute phase , so u did give a very clear modification !
The only thing I remind here is when this sort of Q slam to ur face in the real exam then how u react ?? horse , never, sweat all over . We all hate this kinda of questions, i know for sure. Better ready , guys ...
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| DrAlex_76
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Topics: 120
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DrAlex_76 wrote:
bravo,
nothing to correct whenever u post, so next time dun say correct me if i am....blah blah blah ! just kidding ...
the Q means the acute phase , so u did give a very clear modification !
The only thing I remind here is when this sort of Q slam to ur face in the real exam then how u react ?? horse, nevous, sweat all over . We all hate this kinda of questions, i know for sure. Better ready , guys ...
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| Eagle_303
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Posts: 655
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According to the table given by Harrison the RAP in septic shock : is variable
http://www.prep4usmle.com/forum/thread/69999/
The Eary phase and late phase of septic shock has different pathophysiological parameters.
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| DrAlex_76
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appreciate Eagle, i mean the question asked about the acute phase, otherwise i could have written it more precise.
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| Eagle_303
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DrAlex_76 wrote:
appreciate Eagle, i mean the question asked about the acute phase, otherwise i could have written it more precise.
What is your interpretation about RAP in the early phase in this table. ??
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| DrAlex_76
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maybe decrease ...
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| Eagle_303
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DrAlex_76 wrote:
maybe decrease ...
What do the arrows indicate about RAP in the early phase of Septic shock according to this table ? I need your interpretation friend.
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| DrAlex_76
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i cant get u , Eagle . there 's arrow and i dun think u need my interpretation?!
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| Eagle_303
Forum Guru
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Posts: 655
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Here is the table :
Under CVP and Hyperdynamic phase (which is the first phase ) of Septic shock arrows indicate what ?
Attached Files:
shock.jpg (38 KB, 24 downloads)
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| hero
Forum Guru
Topics: 42
Posts: 549
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To DrAlex_76:
Dear friend, we should mention questions from NBME. Be nice to others.
There are people on the forum who are planning to buy nbme for self-assessment, you are doing not a good job.
Question was discussed recently with proper title -
http://www.prep4usmle.com/forum/thread/74955/
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| DrAlex_76
Forum Guru
Topics: 120
Posts: 410
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To Eagle,
so u mean the answer would be E ?
thanks for the info. I should have read ur post earlier.
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| ngaybinhyen
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Hey guys,
I've looked again re: CV involvement in septic shock/sepsis
1. Preload:
- decreases initially as for relative hypovolemia
- may increase later on
2. Contractility: ALWAYS decreases
-------BUT----
3. Cardiac output:
- initially increases (still relatively lower than demand)
- decreases eventually
4. Afterload:
- decreases initially
- increase eventually
While I'm not against what Eagle has shown, things still need to make sense to me.
===> So I change to A, DrAlex. You didn't correct me. Damn!!
the only weird thing in this thread is I don't see ARLETE happens to say any thing. It's just not right to me...
-t.
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| Eagle_303
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Posts: 655
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If you look at the table which I have uploaded many things will be clear.
Best of luck
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| nightflight1945
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I posted the following in the mentioned question , however nobody noticed :
PLease be notified that increased CO is not equal to increased cardiac contractility. For sure in Septic shock , cardiac contractility DECREASES , and also preload can be high in the initial phase , but not in the later phases.And afterload decreases.Decreased afterload is the main reason for increased CO in the initial phase of septic shock.
The patient is going to advanced stage if septic shock.His BP is 82/44 and that's an ominous sign.
I don't know why everybody has written that cardiac contractility is increased , however it is decreased in septic shock.Again I emphasize that hyperdynamic state is not equal to increased contractility.
I agree with Eagle_303 that preload can increase or decrease in Septic shock , afterload always decrease , and contractility always decrease.
Again I emphasize esp to Eagle that CO is completely different from contractility , In this question I will go for A.
And just one point to Eagle : with all my due respects for him , he is sometimes really stubborn and just write a reference and ignore others or becomes picky and biased.
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| Eagle_303
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nightflight1945 wrote:
I posted the following in the mentioned question , however nobody noticed :
And just one point to Eagle : with all my due respects for him , he is sometimes really stubborn and just write a reference and ignore others or becomes picky and biased.
My dear friend !
Honestly I do not understand what do you mean by these comments.
I will definitely appreciate if you could elaborate them and the reason for you feeling.
Best of luck
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| nightflight1945
banned
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I didn't mean to be offensive , just I'm frank .
GL
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| DrAlex_76
Forum Guru
Topics: 120
Posts: 410
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honestly, i dun know why Cardiac contractility is decreased in Septic shock ?
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| DrAlex_76
Forum Guru
Topics: 120
Posts: 410
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It dues to mediators ?
So we done deal with this Q .
Preload is decreased because of low venous return( venous capacitance low )
After load is decreased. ( everybody knows why )
Cardiac contractility ( not CO ) is DECREASED because of mediators.
Many thanks to nightflight !
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