Undifferentiated shock: Difference between revisions

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==Definition==
== 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


SBP <90 in nl pt
== Types ==
 
SBP<100 with h/o HTN or age >60
 
ABG = lactate > 4� or base def < -4
 
MAP = SVR x CO
 
==Types==


{| border="1"
{| border="1"
|-
| Type
| Type
| Skin
| Skin
Line 20: Line 17:
| cold
| cold
| inc
| inc
|
| <br/>
|-
|-
| Obstructive
| Obstructive
| cold
| cold
| inc
| inc
| <nowiki>**</nowiki>
| <br/>
|-
|-
| Cardiogenic
| Cardiogenic
| cold
| cold
| inc/dec
| inc/dec
| ?dysth
| &nbsp;?dysth
|-
|-
| Anaphylactic
| Anaphylactic
Line 40: Line 37:
| warm
| warm
| dec
| dec
|
| <br/>
|}
|}


<nowiki>**PE: no response to IVF, nmlly hypoxic if large enough to cause shock</nowiki>
== Undifferentiated Hypotension Algorithm (Morchi) ==
 
==Undifferentiated Hypotension Algorithm (Morchi)==


Check:
Check:
#HR (age appropriate)
##<40 and >150-180 --> likely HR = Primary etiology
##Pace or Shock
#Volume Status - LVEDP (approx by CVP, IVC, etc.)
##History of volume loss
##Lung Exam
##Mucous membrane
##Ultrasound IVC (RUQ window or AAA)
##Hemeacuu, Guaic
#Contractility (weak heart)
##Bounding/thready pulse, hyperdynamic precordium
##Cardiac Ultrasound
#Low SVR - Vasodilation is the final answer, if all else is negative expect bounding pulse


1) HR (age appropriate)
== Lack of Response to Normal Tx (DDX)==
 
#Cardiac tamponade
<40 and >150-180 --> likely HR = Primary etiology
#Tension PNTX
 
#Adrenal insuffic
Pace or Shock
#Toxin
 
#Allergic Rx
2) Volume Status - LVEDP (approx by CVP, IVC, etc.)
#Occult bleeding (ectopic, A/P)
 
#PE
History of volume loss
#DIC
 
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)<span class="Apple-style-span" style="line-height: 25px"><font size="20px"><font face="Arial">�</font></font></span>==
 
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==


== Source ==
2/06 DONALDSON (Adapted from Tintinalli)
2/06 DONALDSON (Adapted from Tintinalli)


Morchi 2010
Morchi 2010


[[Category:Airway/Resus]]
<br/>[[Category:Airway/Resus]]

Revision as of 07:34, 12 March 2011

Definition

  1. SBP <90 in nl pt
  2. SBP<100 with h/o HTN or age >60
  3. ABG = lactate > 4 or base def < -4
  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

Undifferentiated Hypotension Algorithm (Morchi)

Check:

  1. HR (age appropriate)
    1. <40 and >150-180 --> likely HR = Primary etiology
    2. Pace or Shock
  2. Volume Status - LVEDP (approx by CVP, IVC, etc.)
    1. History of volume loss
    2. Lung Exam
    3. Mucous membrane
    4. Ultrasound IVC (RUQ window or AAA)
    5. Hemeacuu, Guaic
  3. Contractility (weak heart)
    1. Bounding/thready pulse, hyperdynamic precordium
    2. Cardiac Ultrasound
  4. Low SVR - Vasodilation is the final answer, if all else is negative expect bounding pulse

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


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