Difference between revisions of "Undifferentiated shock"

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###If so, HR is likely primary etiology of hypotension
 
###If so, HR is likely primary etiology of hypotension
 
###Pace or cardiovert
 
###Pace or cardiovert
 
 
#Volume Status
 
#Volume Status
 
##What is the LV end-diastolic volume?
 
##What is the LV end-diastolic volume?
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#####CXR for hemothorax
 
#####CXR for hemothorax
 
####Treat with IVF and/or pRBC depending on cause
 
####Treat with IVF and/or pRBC depending on cause
 
 
#Contractility
 
#Contractility
 
##Is the myocardium severely depressed in its contractile function (cardiogenic shock)?
 
##Is the myocardium severely depressed in its contractile function (cardiogenic shock)?
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###Assess for valvular dysfunction (MR, AR)
 
###Assess for valvular dysfunction (MR, AR)
 
###Assess for obstruction (PE, tamponade)  
 
###Assess for obstruction (PE, tamponade)  
 
 
#Systemic Vascular Resistance
 
#Systemic Vascular Resistance
 
##Pathologic vasodilation (decreased SVR) suggested by:
 
##Pathologic vasodilation (decreased SVR) suggested by:

Revision as of 03:50, 7 May 2012

Undifferentiated Hypotension Algorithm

Check/manage the following in order:

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

DDX

  1. Cardiogenic
    1. Acute valvular Regurgitation/VSD
    2. CHF
    3. Dysrhythmia
    4. Ischemia/Infarction
    5. Myocardial contusion
    6. Myocarditis
  2. Obstructive
    1. Air embolism
    2. Aortic Stenosis
    3. Tamponade
    4. PE
    5. Tension PTX
  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

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