Undifferentiated shock: Difference between revisions
| Line 31: | Line 31: | ||
1) HR (age appropriate) | 1) HR (age appropriate) | ||
*<40 and >150-180 --> likely HR = Primary etiology | |||
<40 and >150-180 --> likely HR = Primary etiology | *Pace or Shock | ||
2) Volume Status - LVEDP (approx by CVP, IVC, etc.) | 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) | 3) Contractility (weak heart) | ||
*Bounding/thready pulse, hyperdynamic precordium | |||
*Cardiac Ultrasound | |||
4) Low SVR - Vasodilation is the final answer, if all else is negative | 4) Low SVR - Vasodilation is the final answer, if all else is negative | ||
*expect bounding pulse | |||
==Lack of Response to Normal Tx (DDX) == | ==Lack of Response to Normal Tx (DDX) == | ||
Revision as of 08:40, 2 March 2011
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
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