Undifferentiated shock: Difference between revisions
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== Definition == | == Definition == | ||
#SBP <90 in nl pt | #SBP <90 in nl pt | ||
#SBP<100 with h/o HTN or age >60 | #SBP<100 with h/o HTN or age >60 | ||
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{| border="1" | {| border="1" | ||
|- | |- | ||
| Type | | '''Type''' | ||
| Skin | | '''Skin''' | ||
| HR | | '''HR''' | ||
| Oth | | '''Oth''' | ||
|- | |- | ||
| Hypovolemic | | Hypovolemic | ||
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Check: | Check: | ||
#HR (age appropriate) | #HR (age appropriate) | ||
##<40 and >150-180 --> likely HR = Primary etiology | ##<40 and >150-180 --> likely HR = Primary etiology | ||
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#Low SVR - Vasodilation is the final answer, if all else is negative expect bounding pulse | #Low SVR - Vasodilation is the final answer, if all else is negative expect bounding pulse | ||
== Lack of Response to Normal Tx (DDX)== | == Lack of Response to Normal Tx (DDX) == | ||
#Cardiac tamponade | #Cardiac tamponade | ||
#Tension PNTX | #Tension PNTX | ||
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== Source == | == Source == | ||
2/06 DONALDSON (Adapted from Tintinalli) | 2/06 DONALDSON (Adapted from Tintinalli) | ||
Morchi 2010 | Morchi 2010 | ||
[[Category:Airway/Resus]] | |||
Revision as of 07:35, 12 March 2011
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 |
Undifferentiated Hypotension Algorithm (Morchi)
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
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