Shock Flashcards
Hypovolemic: signs
LOW pre-load / PCWP
low CO/CI
high SVR
Cardiogenic: signs
high pre-load / PCWP
LOW CO/CI
high SVR
Septic: signs
low pre-load / PCWP
high/low CO/CI
LOW SVR
Overall Tx
Hypovolemic: IV fluids
Cardio: Inotropes
Septic: Pressors
Goals
MAP 65+
PCWP 6-12
CI 2.2+
Hypovolemic: tx
-Crystalloids (doc,1-2L)
-Colloids
-Blood (low hgb/hct)
-Pressors (refractory)
Cardiogenic: etiologies
Acute MI, HF, valv disease
TX: dobutamine, dopamine, milrinone
Dobutamine
Pro
-Inotrope + dilator
-Fast on/offset
-Less hypotension vs Mil
Con
-Increase HR
-Proarrhythmic
-BB interaction
BM HAH
Milrinone
Pro
-Inotrope + VD
-Minimal HR effect
-DOC with BB
Con
-More hypotension
-Proarrhythmic
-Slower on/offset
HAD B
Dopamine
Pro
-Inotrope + constrictor
-Good for hypotn
Con
-Increase HR, PCWP, O2 demand
-Proarrhythmic
HOP HAG
Norepinephrine
1st line for septic shock (alpha agent potent)
Useful if hypotn
Decrease arrhythmias vs dopamine
Increase HR
Less B1 effects
FAHA = first, alpha, good for hypo, less arr
Epinephrine
Pro
-Strong B1 agonist
-Help with hypotn
Con
-Increase HR
-Proarrhythmic
Typically for unresponsive patients in septic shock (add to norepinephrine)
Vasopressin
Effective in acidosis
Not monotherapy
Used in septic shock
SAM
Phenylephrine
Septic shock
-No tachycardia
Angiotensin II
Increase BP in septic/distributive shock
