Shock - Diagnosis and Management Summary
• Hypotension: SBP<90, SBP drop >40, MAP<65 (Normotension, HTN possible w/ early shock state)
• Tachycardia > 100 BPM
• Oliguria
• Altered Mental Status (SBP<60)
• Elevated lactate
• qSOFA/SOFA and SIRS
1) Prepare
• Full Set of Vital Signs
• Establish IV/IO Access - 2-large bore (18-gauge) peripheral IV's, Consider IL NS/LR infusion
• Room Setup
- Ultrasound, code cart in rom
- Patient on monitor, telemetry, 12-Lead EKG
• Ensure adequate support
- Call appropriate code
- Notify Seniors
2) Readily Reversibles
3) Stabilize and Survey
4) Workup
5) Analyze and Reverse
• Obstructive Shock
- Distended neck veins, dilated IVC
- Cardiac >> Constrictive pericarditis, Pericardial Tamponade
- Pulmonary >> Acute PE, Tension Pneumothorax
• Hypovolemic Shock
- Dry, Flat, collapsible IVC
- Hemorrhagic >> Transfuse to Hgb>7
- Non-hemorrhagic >> Aggressive volume resuscitation
• Cardiogenic Shock
- MI, arrhythmia, valvulopathy
- Diffuse crackles, elevated JVP, echo abnormalities
- Cath lab? Terminate arrhythmia? Cardiac surgery?
• Distributive Shock
- Septic Aggressive IVF , ABX
- Anaphylactic >> IM Epinephrine
- Neurogenic >> Vasopressors, Inotropes
- Adrenal Insufficiency >> Corticosteroids
Dr. Michael Jones @Jonesy_MA
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