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diagnosis criticalcare management differential ventilation anesthesia anesthesiology checklist intraoperative mechanical noninvasive pacatheter pressures treatment ac adenosine airway algorithm artery assistcontrol
Shock Classification and Differential Diagnosis SHOCK • MAP <65, SBP <90, drop in SBP > 40 •
Shock Classification ... Differential Diagnosis SHOCK ... Failure, Toxins/Medications ... , CVP > 12 • Pulmonary ... Embolism, Tension
Shock - Differential Diagnosis Framework - MAP <65. SBP <90, drop in SBP > 40 -
Shock - Differential ... Failure, Toxins/Medications ... • Obstructive: Pulmonary ... Embolism, Tension ... ) UOP > 0.5 cc/kg
Pulmonary Arterial Catheterization – Use and Interpretation: -Pulmonary arterial catheterization (PAC) has never been shown to improve
or the type of shock ... severe cardiogenic shock ... (eg, acute valvular ... -right atrial pressure ... #SVR
Shock - Diagnosis and Management Summary • Hypotension: SBP<90, SBP drop >40, MAP<65 (Normotension, HTN possible
Prepare • Full Set ... telemetry, 12-Lead EKG ... and Survey 4) Workup ... Tamponade - Pulmonary ... criticalcare #treatment #workup
Right Heart Catheterization - Pulmonary Artery Pressures and Calculations PULMONARY VASCULAR RESISTANCE = (meanPAP-PCWP) / CO •
Artery Pressures ... RV dysfunction. e.g ... , SVR T as a compensatory ... low or normal SVR ... forward flow. e.g
Approach to Undifferentiated Shock - OnePager Summary Shock occurs when there is inadequate blood flow (CO) &
Cardiac Tamponade, Pulmonary ... Embolism, Outflow ... Pipes Problem (↓ SVR ... amniotic or fat embolism ... thyrotoxicosis), Medications
Clinical Management for Three Common Causes of Shock HEMORRHAGIC SHOCK • Ensure adequate ventilation and oxygenation.
fractures, direct pressure ... Ameliorate increased work ... end-expiratory pressure ... (PEEP) for pulmonary ... oxygenation; remove work
Perform computations online at: ScyMed.com 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
Hypovolemic shock ... ↑ Cardiogenic shock ... 1 ↑ Septic shock ... Embolism ↓ ↑ ... LCWI 3.4-4.2 kg
Noninvasive Positive Pressure Ventilation (NIPPV) Expiratory & Inspiratory Positive Airway Pressure Both increase intrathoracic pressure, which can decrease
potentially improving SV ... generate larger VT ... exacerbation (cardiogenic pulmonary ... status • Won't Work ... NIPPV #CPAP #BPAP #indications
SPONT - Spontaneous Breathing = Pressure Support Ventilation Summary Basic Set Parameters: 1) Pressure Support (PS)
Parameters: 1) Pressure ... do some of the work ... means the patient ↑work ... > 8cc/kg at 6/6 ... #Ventilation #pulmonary
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