Shock syndrome
Terms
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- What are the consequences of shock
- death or multiple organ dysfunction
- Clinical presentation of shock
-
SBP <90 or MAP <65
Tachy >90
Tachypnea RR >20
altered mental status
decreased organ perfusion decreased urine output
metabolic acidosis - Hemodynamics of Hypovolemic shock
-
decrease PCWP
decrease CO
increase SVR - Hemodynamics of cardiogenic shock
-
decease CO
increase PCWP
increase SVR - Hemodynamics of septic shock
-
decrease SVR
increase CO
decrease PCWP - What is hypovolemic shock and etiologies
-
Hemorrhagic
-trauma/surgery
-internal bleeding
--aortic aneurysm
--gi bleed
--retroperitoneal bleed
Non-hemorrhagic
-dehydration
-ascities
-fluid loss burns,heat stroke - Goals of hypovolemic shock
-
PCWP 10-12
CVP 15
CI 3 L/min - What is cardiogenic shock
- sustained hypotension and reduced CI leads to inadequate tissure perfusion due to cardiac dysfuction
- Causes of cardiogenic shock
-
acute Mitral regurg
rupture of interventricular septum
acute MI
myocarditis
end-stage cardiomyopathy
myocardial contusion
septic shock with sever myocardial depression
valvular heart dz
hypertrophic obstructive cardiomyopathy - Goals of management of cardiogenic shock
-
CI >2.5
PCWP <18
MAP >65
Uout >0.5 ml/kg/hr - Rationale of inotropes in cardiogenic shock
-
increase contracility increase HR and CO
peripheral vasodilation - rationale of vasopressors in cardiogenic shock
- increase MAP
- rationale of diuretics in cardiogenic shock
- decrease PCWP
- rationale of vasodilators in cardiogenic shock
- decrease SVR but last line
- Mechanical options for cardiogenic shock
-
intra-aortic balloon pump
ventricular assist device
bi-vent assist device - primary etiology of responsible of vasodilatory shock also called septic
-
infections
anaphylaxis
neurogenic
drug-induced
acute adrenal insuffciency - what is sepsis
- SIRS with presence of infection
- what is severe sepsis
- sepsis with organ dysfunction defined my MODS of SOFA
- What is septic shock
- sepsis with hypotension despite adequate volume resus. SBP <90 of MAP <60
- What qualilfies as systemic inflammatory response syndrome (SIRS)
-
core temp >38.3 <36
HR >90
RR >20 or PaO2 <32
WBC >12,000 or <4000 or >10% bands