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
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