Undifferentiated shock: Difference between revisions
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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:
- 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
- Too slow or too fast (to the point where CO is affected)?
- 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
- Assess for blood loss versus fluid loss
- What is the LV end-diastolic volume?
- Contractility
- Is the myocardium severely depressed in its contractile function (cardiogenic shock)?
- Assess via ultrasound
- Treat w/ inotrope
- Is forward flow occurring?
- Assess for valvular dysfunction (MR, AR)
- Assess for obstruction (PE, tamponade)
- Is the myocardium severely depressed in its contractile function (cardiogenic shock)?
- Systemic Vascular Resistance
- Pathologic vasodilation (decreased SVR) suggested by:
- Warm extremities
- Bounding pulse
- Treated based on likely etiology of distributive shock (see below)
- Pathologic vasodilation (decreased SVR) suggested by:
DDX
- Cardiogenic
- Acute valvular Regurgitation/VSD
- CHF
- Dysrhythmia
- Ischemia/Infarction
- Myocardial contusion
- Myocarditis
- Obstructive
- Air embolism
- Aortic Stenosis
- Tamponade
- PE
- Tension PTX
- Distributive
- Adrenal Crisis
- Anaphylaxis
- Neurogenic
- Sepsis
- Toxicologic
- Hypovolemic
- Hemorrhage (traumatic and non-traumatic)
- Severe dehydration
See Also
Source
- Tintinalli
- Morchi, Undifferentiated Hypotension and Shock, All LA Conference, 05/06/2010