Difference between revisions of "Undifferentiated shock"

m (Rossdonaldson1 moved page Shock to Undifferentiated shock)
(Differential Diagnosis)
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==Differential Diagnosis==
 
==Differential Diagnosis==
 
{{Shock DDX}}
 
{{Shock DDX}}
 
***Classes of Hemorrhagic Shock
 
{| class="wikitable"
 
! Class
 
! I
 
! II
 
! III
 
! IV
 
|-
 
| Blood Loss (mL)
 
| < 750
 
| 750-1000
 
| 1500-2000
 
| >2000
 
|-
 
| Blood Loss (%)
 
| < 15
 
| 15-30
 
| 30-40
 
| >40
 
|-
 
| Pulse rate (per min)
 
| <100
 
| 100-120
 
| 120-140
 
| >140
 
|-
 
| Blood Pressure
 
| Normal
 
| Normal
 
| Decreased
 
| Decreased
 
|-
 
| Pulse Pressure (mmHg)
 
| Normal or Increased
 
| Decreased
 
| Decreased
 
| Decreased
 
|-
 
| Respiratory Rate (per min)
 
| 14-20
 
| 20-30
 
| 30-40
 
| >35
 
|-
 
| Urine Output (mL/hr)
 
| >30
 
| 20-30
 
| 15-May
 
| Negligble
 
|-
 
| Mental Status
 
| Slightly Anxious
 
| Mildly Anxious
 
| Anxious, Confused
 
| Confused, Lethargic
 
|}
 
  
 
==See Also==
 
==See Also==

Revision as of 07:38, 18 February 2015

Undifferentiated Hypotension Algorithm

Check/manage the following in order:

  • Pulse (assess based on pt's age)
    • Too slow or too fast (to the point where CO is affected)?
      • If so, HR is likely primary etiology of hypotension
      • Pace or cardiovert
  • Volume Status
    • What is the LV end-diastolic volume?
      • Approximated by the IVC diameter or CVP
      • If low:
        • Assess for blood loss versus fluid loss
          • FAST for intra-abdominal bleed
          • US for ruptured AAA
          • Guaiac for GI bleed
          • CXR for hemothorax
        • Treat with IVF and/or pRBC depending on cause
  • Contractility
    • Is the myocardium severely depressed in its contractile function (cardiogenic shock)?
    • Is forward flow occurring?
      • Assess for valvular dysfunction (MR, AR)
      • Assess for obstruction (PE, tamponade)
  • Systemic Vascular Resistance
    • Pathologic vasodilation (decreased SVR) suggested by:
      • Warm extremities
      • Bounding pulse
    • Treated based on likely etiology of distributive shock (see below)

Differential Diagnosis

Shock

See Also

Source

  • Tintinalli
  • Morchi, Undifferentiated Hypotension and Shock, All LA Conference, 05/06/2010