Undifferentiated shock
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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:
- 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:
Differential Diagnosis
- Cardiogenic
- Acute valvular Regurgitation/VSD
- CHF
- Dysrhythmia
- ACS
- Myocardial Contusion
- Myocarditis
- Obstructive
- Air embolism
- Aortic Stenosis
- Cardiac Tamponade
- PE
- Tension pneumothorax
- Distributive
- Adrenal Crisis
- Anaphylaxis
- Neurogenic Shock
- Sepsis
- Toxicologic
- Hypovolemic
- Severe dehydration
- Hemorrhagic shock (traumatic and non-traumatic)
- Classes of Hemorrhagic Shock
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
Source
- Tintinalli
- Morchi, Undifferentiated Hypotension and Shock, All LA Conference, 05/06/2010