Undifferentiated shock
Revision as of 16:11, 5 July 2011 by Rossdonaldson1 (talk | contribs) (→Undifferentiated Hypotension Algorithm)
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 |
Distributive | warm | inc | |
Neurogenic | warm | dec |
Undifferentiated Hypotension Algorithm
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
- HR
- Too high (>180) or too low
- Tx with cardioversion/defib or pace
- Too high (>180) or too low
- Volume
- Plasma vs. RBC loss
- Evaluate CVP, IVC, UOP
- Check for GI, intraperitoneal, lung, retroperitoneal loss/sequestration
- Plasma vs. RBC loss
- Contractility
- Dx with ultrasound
- Will have high afterload
- May be due to STEMI, CHF
- Will have high afterload
- Dx with ultrasound
- Forward flow
- Valvular dysfunction (MR) or obstruction
- Evaluate via auscultation, ultrasound
- Consider PE, HOCM
- Evaluate via auscultation, ultrasound
- Valvular dysfunction (MR) or obstruction
- SVR
- Pathologic vasodilation
- Warm extremities, bounding pulse
- Consider sympathetic dysregulation/neurogenic shock
- Warm extremities, bounding pulse
- Cool extremities and "normal" BP
- Consider vasoconstriction and treat as hypotension from the top
- Pathologic vasodilation
Lack of Response to Normal Tx (DDX)
- Cardiac tamponade
- Tension PNTX
- Adrenal insuffic
- Toxin
- Allergic Rx
- Occult bleeding (ectopic, A/P)
- PE
- DIC
Source
2/06 DONALDSON (Adapted from Tintinalli)
Morchi 2010