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6th ED
ICU-card
«ICU, Formulas & Drugs»
HEMODYNAMIC PATTERNS
Condition
SAP
CVP

PAP PCWP

CO C(a-v)02 PVR

SVR
Hypovolemic shock
↓
↓
↓
↓
↓
↑
↑
↑
Cardiogenic shock
↓
1
↑
1

1
↑

Septic shock
↓
↓
↓
↓
↑
↓
↓
↓
Cardiac Tamponade
.
↑
↑
1
↓

→
↑
RV
SVR Hypovolemic shock ... ↑ Cardiogenic shock ... 1 ↑ Septic shock ... L/min/m2 HR*SV ... /SV Heart Rate
POCUS - Measuring Cardiac Output
1) Calculate LVOT Area
2) Calculate LVOT VTI
3) Calculate Cardiac Output

SV = (LVOT
Cardiac Output SV ... ) x (LVOT VTI) CO ... LVOT VTI) X HR CO ... (mL/min) = SV ( ... Cardiac #Output #CO
Shock Classification and Differential Diagnosis
SHOCK
 • MAP <65, SBP <90, drop in SBP > 40
 •
Shock Classification ... Differential Diagnosis SHOCK ... Distributive: • High CO ... Cardiogenic: • Low CO ... Sophia_Hayes_MD #Shock
Shock - Differential Diagnosis Framework
MAP = CO x SVR
Hypovolemic (↓ Intravascular volume):
 • Hemorrhage, dehydration due
Shock - Differential ... Framework MAP = CO ... third-spacing • ↓ CO ... arrhythmia • ↓ CO ... uw_IMresidency #Shock
Approach to Undifferentiated Shock - OnePager Summary
Shock occurs when there is inadequate blood flow (CO) &
Undifferentiated Shock ... OnePager Summary Shock ... inadequate blood flow (CO ... Pump Problem (↓ CO ... may develop low CO
Shock - Differential Diagnosis Framework
 - MAP <65. SBP <90, drop in SBP > 40
 -
Shock - Differential ... Lactate > 1.5 High CO ... Cord Injury Low CO ... Dehydration Shock ... Sophia_Hayes_MD #Shock
Shock Overview
A state of tissue hypoxia due to decreased or dysregulated oxygen delivery or extraction, resulting
Shock Overview ... of hypotension Shock ... - Low CO and therefore ... - Low CO and therefore ... - Low CO and therefore
Vasopressors and Inotropes - Pharmacology Summary
Vasopressors
Phenylephrine (alpha-1)
 • Increases BP, SVR
 • Risk of reflex bradycardia
Increases BP, SVR, CO ... first agent in shock ... Increases HR, SVR, CO ... line in septic shock ... contractility, CO
Shock Overview
A state of tissue hypoxia due to decreased or dysregulated oxygen delivery or extraction, resulting
Shock Overview ... of hypotension Shock ... - Low CO and therefore ... - Low CO and therefore ... - Low CO and therefore
Common Vasopressors and Inotropes
Norepinephrine (NE)
 - Indication: Distributive shock (1st line for septic shock), Cardiogenic shock
: Distributive shock ... line for septic shock ... ), Cardiogenic shock ... (mild ↑CO) - Side ... , Shock where ↑