Shock

Question 1

Shock, Presentation

Answer 1

-SBP < 90 (or decreased 40+ from baseline)
-MAP < 65
-HR > 90
-RR > 20
-Oliguria, UOP < 20
-AMS
-Increased lactate, metabolic acidosis

Question 2

Types of Shock

Answer 2

1. Hypovolemic
   -Preload: IV fluids
2. Cardiogenic
   -CO: Inotropes
3. Septic
   -Afterload: Pressors

Question 3

TX Overview

Answer 3

-Fluid Resuscitation
-Pressors/Inotropes

Goals
-MAP 65+
-Cl 2.2+
-SvO2 65%+
-CVP 2-6
-PCWP 6-12

Question 4

Hypovolemic Shock

Answer 4

Crystalloids
-Inexpensive, easy
-3-4x more vol, no O2

Colloids
-Longer duration, increased intra volume
-More expensive, not clinically superior

Summary
-Control source of volume loss
-Crystalloid is fluid of choice
-Reserve blood for low Hgb/Hct and reserve inotropes/pressors for refractory shock

Question 5

Cardiogenic Shock

Answer 5

Etiology: MI, HF, VD

Dobutamine <10 mcg/kg/min
-BB interaction, increase HR, less hypotension

Milrinone 0.75
-More hypo, slower onset

Norepinephrine 1-50
-Less potent B1, increase HR

Dopamine 3-10
-Consider if low CO and mod/sev hypotension

Epinephrine
-Post CT surgery or cardio shock

Question 6

Septic Shock

Answer 6

1st line = Norepinephrine 0.5-50

2 = Vasopressin 0.03
*not mono

3 = Epi
*add to norepi (unresponsive pts)

4 = IV steroids

-Phenylephrine
*if tachy/arrhythmia

Question 7

Extravestation

Answer 7

Phentolamine SQ