Undifferentiated shock: Difference between revisions

Revision as of 07:15, 18 February 2015

Check/manage the following in order:

Pulse (assess based on pt's age)
- Too slow or too fast (to the point where CO is affected)?
  - If so, HR is likely primary etiology of hypotension
  - Pace or cardiovert
Volume Status
- What is the LV end-diastolic volume?
  - Approximated by the IVC diameter or CVP
  - If low:
    - Assess for blood loss versus fluid loss
      - FAST for intra-abdominal bleed
      - US for ruptured AAA
      - Guaiac for GI bleed
      - CXR for hemothorax
    - Treat with IVF and/or pRBC depending on cause
Contractility
- Is the myocardium severely depressed in its contractile function (cardiogenic shock)?
  - Assess via ultrasound
  - Treat w/ inotrope
- Is forward flow occurring?
  - Assess for valvular dysfunction (MR, AR)
  - Assess for obstruction (PE, tamponade)
Systemic Vascular Resistance
- Pathologic vasodilation (decreased SVR) suggested by:
  - Warm extremities
  - Bounding pulse
- Treated based on likely etiology of distributive shock (see below)

Class	I	II	III	IV
Blood Loss (mL)	< 750	750-1000	1500-2000	>2000
Blood Loss (%)	< 15	15-30	30-40	>40
Pulse rate (per min)	<100	100-120	120-140	>140
Blood Pressure	Normal	Normal	Decreased	Decreased
Pulse Pressure (mmHg)	Normal or Increased	Decreased	Decreased	Decreased
Respiratory Rate (per min)	14-20	20-30	30-40	>35
Urine Output (mL/hr)	>30	20-30	15-May	Negligble
Mental Status	Slightly Anxious	Mildly Anxious	Anxious, Confused	Confused, Lethargic

Authors:

@@ Line 30: / Line 30: @@
 ==Differential Diagnosis==
-*Cardiogenic
+{{Shock DDX}}
-**Acute valvular Regurgitation/VSD
-**[[CHF]]
-**[[Dysrhythmia]]
-**[[ACS]]
-**[[Myocardial Contusion]]
-**[[Myocarditis]]
-*Obstructive
-**Air embolism
-**[[Aortic Stenosis]]
-**[[Cardiac Tamponade]]
-**[[PE]]
-**[[Tension pneumothorax]]
-*Distributive
-**Adrenal Crisis
-**[[Anaphylaxis]]
-**[[Neurogenic Shock]]
-**[[Sepsis]]
-**[[Toxicology (Main)|Toxicologic]]
-*Hypovolemic
-**Severe dehydration
-**[[Hemorrhagic shock]] (traumatic and non-traumatic)
 ***Classes of Hemorrhagic Shock