Undifferentiated shock: Difference between revisions
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#Volume Status | #Volume Status | ||
##What is the LV end-diastolic volume? | ##What is the LV end-diastolic volume? | ||
###Approximated by the | ###Approximated by the IVC diameter or CVP | ||
###If low: | ###If low: | ||
####Assess for blood loss versus fluid loss | ####Assess for blood loss versus fluid loss | ||
| Line 59: | Line 59: | ||
#Contractility | #Contractility | ||
##Is the myocardium severely depressed in its contractile function? | ##Is the myocardium severely depressed in its contractile function (cardiogenic shock)? | ||
###Assess via ultrasound | ###Assess via ultrasound | ||
###Treat w/ inotrope | |||
##Is forward flow occurring? | ##Is forward flow occurring? | ||
###Assess for valvular dysfunction (MR, AR) | ###Assess for valvular dysfunction (MR, AR) | ||
###Assess for obstruction (PE, | ###Assess for obstruction (PE, tamponade) | ||
#Systemic Vascular Resistance | #Systemic Vascular Resistance | ||
| Line 69: | Line 70: | ||
###Warm extremities | ###Warm extremities | ||
###Bounding pulse | ###Bounding pulse | ||
## | ##Treated based on likely etiology (see [[Distributive Shock]] | ||
== Lack of Response to Normal Treatment (DDX) == | |||
#Cardiogenic | #Cardiogenic | ||
##Acute | ##Acute valvular Regurgitation/VSD | ||
##CHF | ##CHF | ||
##Dysrhythmia | ##Dysrhythmia | ||
##Ischemia/Infarction | ##Ischemia/Infarction | ||
##Myocardial | ##Myocardial contusion | ||
##Myocarditis | |||
#Obstructive | #Obstructive | ||
##Air embolism | ##Air embolism | ||
##Aortic Stenosis | ##Aortic Stenosis | ||
## | ##Tamponade | ||
## | ##PE | ||
##Tension | ##Tension PTX | ||
#Distributive | #Distributive | ||
##Adrenal Crisis | ##Adrenal Crisis | ||
| Line 92: | Line 93: | ||
##Toxicologic | ##Toxicologic | ||
#Hypovolemic | #Hypovolemic | ||
##Hemorrhage | ##Hemorrhage (traumatic and non-traumatic) | ||
##Severe | ##Severe dehydration | ||
==See Also== | ==See Also== | ||
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== Source == | == Source == | ||
*Tintinalli) | |||
*Morchi, Undifferentiated Hypotension and Shock, All LA Conference, 05/06/2010 | |||
Morchi 2010 | |||
[[Category:Airway/Resus]] | [[Category:Airway/Resus]] | ||
[[Category:Cards]] | [[Category:Cards]] | ||
Revision as of 03:37, 7 May 2012
Definition
- SBP <90 in normal pt
- SBP <100 with h/o HTN or age >60
- Lactate > 4 or base def < -4
Types
| Type | Skin | HR | Oth |
| Hypovolemic | cold | inc | |
| Obstructive | cold | inc | |
| Cardiogenic | cold | inc/dec | ?dysth |
| Distributive | warm | inc | |
| Neurogenic | warm | dec |
Undifferentiated Hypotension Algorithm
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
- Too slow or too fast (to the point where CO is affected)?
- 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
- Assess for blood loss versus fluid loss
- What is the LV end-diastolic volume?
- 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)
- Is the myocardium severely depressed in its contractile function (cardiogenic shock)?
- Systemic Vascular Resistance
- Pathologic vasodilation (decreased SVR) suggested by:
- Warm extremities
- Bounding pulse
- Treated based on likely etiology (see Distributive Shock
- Pathologic vasodilation (decreased SVR) suggested by:
Lack of Response to Normal Treatment (DDX)
- Cardiogenic
- Acute valvular Regurgitation/VSD
- CHF
- Dysrhythmia
- Ischemia/Infarction
- Myocardial contusion
- Myocarditis
- Obstructive
- Air embolism
- Aortic Stenosis
- Tamponade
- PE
- Tension PTX
- Distributive
- Adrenal Crisis
- Anaphylaxis
- Neurogenic
- Sepsis
- Toxicologic
- Hypovolemic
- Hemorrhage (traumatic and non-traumatic)
- Severe dehydration
See Also
Source
- Tintinalli)
- Morchi, Undifferentiated Hypotension and Shock, All LA Conference, 05/06/2010