Shock resident survival guide: Difference between revisions
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:*Electrical eg [[ventricular tachycardia|VT]] or [[atrial fibrillation|AF]] or most fundamentally [[ventricular fibrillation|VF]] | :*Electrical eg [[ventricular tachycardia|VT]] or [[atrial fibrillation|AF]] or most fundamentally [[ventricular fibrillation|VF]] | ||
*'''Hypovolemic shock''' | *'''Hypovolemic shock'''- In this situation true loss of circulatory volume. | ||
:True [[hypovolemia]] | :True [[hypovolemia]] | ||
::*Bleeding i.e [[hemorrhagic shock]] | ::*Bleeding i.e [[hemorrhagic shock]] | ||
::*Fluid loss (e.g. [[diarrhoea]], [[vomiting]], bowel obstruction, 'third' spacing) | ::*Fluid loss (e.g. [[diarrhoea]], [[vomiting]], bowel obstruction, 'third' spacing) | ||
*'''Redistributive hypovolemia shock'''- In this situation there is diminishing of effective circulatory volume. | |||
::*[[Anaphylaxis]] | ::*[[Anaphylaxis]] | ||
::*[[Neurogenic shock]] | ::*[[Neurogenic shock]] | ||
::*[[Septic shock]] | ::*[[Septic shock]] | ||
*'''[[Obstructive shock]]''' - In this situation the flow of blood is obstructed which impedes circulation and can result in [[circulatory arrest]]. Several conditions result in this form of shock. | |||
::*[[Cardiac tamponade]] in which blood in the pericardium prevents inflow of blood into the heart (venous return). | |||
::*[[Constrictive pericarditis]], in which the[[pericardium]] shrinks and hardens, is similar in presentation. | |||
::*[[Tension pneumothorax]]. Through increased intrathoracic pressure, blood flow to the heart is prevented (venous return). | |||
::*Massive [[pulmonary embolism]] is the result of a thromboembolic incident in the blood vessels of the [[lung]]s and hinders the return of blood to the heart. | |||
::*[[Aortic stenosis]] hinders circulation by obstructing the [[ventricular outflow tract]] | |||
*'''Endocrine shock''' based on [[endocrine]] disturbances. | |||
::*[[Hypothyroidism]], in critically ill patients, reduces [[cardiac output]] and can lead to hypotension and respiratory insufficiency. | |||
::*[[Hyperthyroidism|Thyrotoxicosis]] may induce a reversible cardiomyopathy. | |||
::*Acute [[adrenal insufficiency]] is frequently the result of discontinuing [[corticosteroid]] treatment without tapering the dosage. However, surgery and intercurrent disease in patients on corticosteroid therapy without adjusting the dosage to accommodate for increased requirements may also result in this condition. | |||
::*Relative [[adrenal insufficiency]] in critically ill patients where present [[cortisol|hormone levels]] are insufficient to meet the higher demands | |||
===Prognosis=== | ===Prognosis=== | ||
Revision as of 21:34, 3 December 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Zaghw, M.D. [2]
Definition
Causes
Life Threatening Causes
Common Causes
- Cardiogenic shock
- Pump problems (e.g. post-MI), cardiomyopathy
- Mechanical (e.g. cardiac tamponade, tension pneumothorax), aortic stenosis
- Electrical eg VT or AF or most fundamentally VF
- Hypovolemic shock- In this situation true loss of circulatory volume.
- True hypovolemia
- Bleeding i.e hemorrhagic shock
- Fluid loss (e.g. diarrhoea, vomiting, bowel obstruction, 'third' spacing)
- Redistributive hypovolemia shock- In this situation there is diminishing of effective circulatory volume.
- Obstructive shock - In this situation the flow of blood is obstructed which impedes circulation and can result in circulatory arrest. Several conditions result in this form of shock.
- Cardiac tamponade in which blood in the pericardium prevents inflow of blood into the heart (venous return).
- Constrictive pericarditis, in which thepericardium shrinks and hardens, is similar in presentation.
- Tension pneumothorax. Through increased intrathoracic pressure, blood flow to the heart is prevented (venous return).
- Massive pulmonary embolism is the result of a thromboembolic incident in the blood vessels of the lungs and hinders the return of blood to the heart.
- Aortic stenosis hinders circulation by obstructing the ventricular outflow tract
- Endocrine shock based on endocrine disturbances.
- Hypothyroidism, in critically ill patients, reduces cardiac output and can lead to hypotension and respiratory insufficiency.
- Thyrotoxicosis may induce a reversible cardiomyopathy.
- Acute adrenal insufficiency is frequently the result of discontinuing corticosteroid treatment without tapering the dosage. However, surgery and intercurrent disease in patients on corticosteroid therapy without adjusting the dosage to accommodate for increased requirements may also result in this condition.
- Relative adrenal insufficiency in critically ill patients where present hormone levels are insufficient to meet the higher demands
Prognosis
Management
| Shock | |||||||||||||||||||||||||||||
| ABCD Airway / O2 / 2 wide bore IV access / 12-lead ECG / focused H&P / CXR | |||||||||||||||||||||||||||||
| Volume defect | Pump defect | Heart Rate disturbances | |||||||||||||||||||||||||||
| Fluid/Blood products ± Vasopressors | Arrhythmia algorithm | ||||||||||||||||||||||||||||
| SBP < 70 with cardiogenic shock | SBP 70-100 with cardiogenic shock | SBP 70-100 with no cardiogenic shock | |||||||||||||||||||||||||||
| Norepinephrine 1-30 μg/min | Dopamine 2–20 μg/kg/min | Dobutamine 2–20 μg/kg/min | |||||||||||||||||||||||||||