Undifferentiated shock

Definition

SBP <90 in nl pt

SBP<100 with h/o HTN or age >60

ABG = lactate > 4� or base def < -4

MAP = SVR x CO

Types

Type	Skin	HR	Oth
Hypovolemic	cold	inc
Obstructive	cold	inc	**
Cardiogenic	cold	inc/dec	?dysth
Anaphylactic	warm	inc	hives
Neurogenic	warm	dec

**PE: no response to IVF, nmlly hypoxic if large enough to cause shock

Undifferentiated Hypotension Algorithm (Morchi)

Check:

1) HR (age appropriate)

<40 and >150-180 --> likely HR = Primary etiology

Pace or Shock

2) Volume Status - LVEDP (approx by CVP, IVC, etc.)

History of volume loss

Lung Exam

Mucous membrane

Ultrasound IVC (RUQ window or AAA)

Hemeacuu, Guaic

3) Contractility (weak heart)

Bounding/thready pulse, hyperdynamic precordium

Cardiac Ultrasound

4) Low SVR - Vasodilation is the final answer, if all else is negative

expect bounding pulse

Adapted from Morchi

Lack of Response to Normal Tx (DDX)�

1)� Cardiac tamponade

2)� Tension PNTX

3)� Adrenal insuffic

4)� Toxin

5)� Allergic Rx

6)� Occult bleeding (ectopic, A/P)

7)� PE

8)� DIC

Source

2/06 DONALDSON (Adapted from Tintinalli)

Morchi 2010