Shock Flashcards
Target Central Venous Pressure
8-12 mmHg, 12-15 mmHg intubated patients
Fluid Resuscitation
Initial: crystalloid (NS or LR); challenge min of 30 mg/kg w/in first 3 h; albumin add’n
Albumin in Resuscitation
Pt requires substantial amount of crystalloid, pt develops incr abdominal pressure or pulmonary edema
Hydroxyethyl Starches
Avoid in fluid resuscitation
Target of Resuscitation
MAP of at least 65 mmHg, UO of at least 0.5 L/kg/h, normal lactate
Vasopressors
Central line preferred, Norepinephrine (1st choice), epinephrine (add’n to or sub for norEpi), vasopressin (add to norEpi before Epi), Dopamine (highly select pts), Phenylephrine (not rec)
Norepinephrine
Initial 0.05 mcg/kg/min or 4 mcg/min; Max approx: 3 mcg/kg/min or 125 mcg/min
Epinephrine
Initial: 0.05 mcg/kg/min; Range: 2-10 mcg/min
Vasopressin
Indication: refractory septic shock, 1st line: malignant tachy or active coronary ischemia, dose: 0.01-0.04 units/min
Dopamine
Indication: pt w/ low risk of tachy; dose: 2.5-20 mcg/kg/min
Phenylephrine
Indication: NorEpi-assoc arrhythmias, high CO states, salvage tx; Dose: 100 mcg bolus or 50 mcg/min, Max: 400 mcg/min
Inotropes
Potentially useful in resuscitated pt w/ persistent evidence of systemic or organ hypoperfusion; Dobutamine and Milrinone
Dobutamine
Dose: 2.5-10 mcg/kg/min up to 20 mcg/kg/min; may cause hypotension and tachy
Milrinone
Dose: 0.2-0.75 mcg/kg/min (lower in renal pts), LD: 50 mcg/kg over 10 min may be used; monotx or combo with dobutamine
Corticosteroid Stress Dose
After fluids and vasopressors, hydrocortisone 50 mg iv q6h or 100 mg VI q8h for 7d