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