Difference between revisions of "Undifferentiated shock"

(See Also)
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== Definition ==
 
== Definition ==
 
+
#SBP <90 in normal pt
#SBP <90 in nl pt
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#SBP <100 with h/o HTN or age >60
#SBP<100 with h/o HTN or age >60
+
#Lactate > 4 or base def < -4
#ABG = lactate > 4 or base def < -4
 
#MAP = SVR x CO
 
  
 
== Types ==
 
== Types ==

Revision as of 02:04, 7 May 2012

Definition

  1. SBP <90 in normal pt
  2. SBP <100 with h/o HTN or age >60
  3. Lactate > 4 or base def < -4

Types

Type Skin HR Oth
Hypovolemic cold inc
Obstructive cold inc
Cardiogenic cold inc/dec  ?dysth
Distributive warm inc
Neurogenic warm dec

Undifferentiated Hypotension Algorithm

Check:

  1. HR (age appropriate)
    1. <40 and >150-180 --> likely HR = Primary etiology
      1. Tx with cardioversion/defib or pace
    2. Plasma vs. RBC loss
      1. Evaluate CVP, IVC, UOP
      2. Check for GI, intraperitoneal, lung, retroperitoneal loss/sequestration
  2. Contractility
    1. Bounding/thready pulse, hyperdynamic precordium
    2. Dx with ultrasound
      1. Will have high afterload
        1. May be due to STEMI, CHF
  3. Forward flow
    1. Valvular dysfunction (MR) or obstruction
      1. Evaluate via auscultation, ultrasound
        1. Consider PE, HOCM
  4. Volume Status - LVEDP (approx by CVP, IVC, etc.)
    1. History of volume loss
    2. Lung Exam
    3. Mucous membrane
    4. Ultrasound IVC (RUQ window or AAA)
    5. Hemeacuu, Guaic
    6. Cardiac Ultrasound
  5. SVR
    1. Pathologic vasodilation
      1. Warm extremities, bounding pulse
        1. Consider sympathetic dysregulation/neurogenic shock
    2. Cool extremities and "normal" BP
      1. Consider vasoconstriction and treat as hypotension from the top

Lack of Response to Normal Tx (DDX)

  1. Cardiogenic
    1. Acute Valvular Regurg/VSD
    2. CHF
    3. Dysrhythmia
    4. Ischemia/Infarction
    5. Myocardial Contusion/Myocarditis
  2. Obstructive
    1. Air embolism
    2. Aortic Stenosis
    3. Cardiac Tamponade
    4. Massive PE
    5. Tension Pneumo
  3. Distributive
    1. Adrenal Crisis
    2. Anaphylaxis
    3. Neurogenic
    4. Sepsis
    5. Toxicologic
  4. Hypovolemic
    1. Hemorrhage Traumatic and Non-traumatic
    2. Severe Dehydration

See Also

Source

2/06 DONALDSON (Adapted from Tintinalli)

Morchi 2010