Undifferentiated shock
Revision as of 16:34, 12 March 2011 by Rossdonaldson1 (talk | contribs)
Definition
- SBP <90 in nl pt
- SBP<100 with h/o HTN or age >60
- ABG = lactate > 4 or base def < -4
- MAP = SVR x CO
Types
Type | Skin | HR | Oth |
Hypovolemic | cold | inc | |
Obstructive | cold | inc | |
Cardiogenic | cold | inc/dec | ?dysth |
Anaphylactic | warm | inc | hives |
Neurogenic | warm | dec |
Undifferentiated Hypotension Algorithm
Check:
- HR (age appropriate)
- <40 and >150-180 --> likely HR = Primary etiology
- Pace or Shock
- Volume Status - LVEDP (approx by CVP, IVC, etc.)
- History of volume loss
- Lung Exam
- Mucous membrane
- Ultrasound IVC (RUQ window or AAA)
- Hemeacuu, Guaic
- Contractility (weak heart)
- Bounding/thready pulse, hyperdynamic precordium
- Cardiac Ultrasound
- Low SVR - Vasodilation is the final answer, if all else is negative expect bounding pulse
Lack of Response to Normal Tx (DDX)
- Cardiac tamponade
- Tension PNTX
- Adrenal insuffic
- Toxin
- Allergic Rx
- Occult bleeding (ectopic, A/P)
- PE
- DIC
Source
2/06 DONALDSON (Adapted from Tintinalli)
Morchi 2010