Sandbox/001

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Circulatory shock

Definition

Shock is the clinical expression of circulatory failure that results in inadequate cellular oxygen utilization.

Causes

Shock is a life-threatening condition and must be treated as such irrespective of the causes.

Classification

Hemodynamic Profiles of Shock

Type of Shock		CO	SVR	PCWP	CVP	SVO2	Feature
Cardiogenic	Acute Ventricular Septal Defect	↓↓	↑	N — ↑	↑↑	↑ — ↑↑	↑ JVP, hepatojugular reflux, S3, S4, murmurs
	Acute Mitral Regurgitation	↓↓	↑	↑↑	↑ — ↑↑	↓
	Myocardial Infarction	↓↓	↑	↑↑	↑↑	↓
Obstructive	Pulmonary Embolism	↓↓	↑	N — ↓	↑↑	↓
	Cardiac Tamponade	↓ — ↓↓	↑	↑↑	↑↑	↓
Distributive	Septic Shock	N — ↑↑	↓ — ↓↓	N — ↓	N — ↓	↑ — ↑↑
	Anaphylactic Shock	N — ↑↑	↓ — ↓↓	N — ↓	N — ↓	↑ — ↑↑
Hypovolemic	Volume Depletion	↓↓	↑	↓↓	↓↓	↓	↓ JVP

Management

Symptoms & Signs ❑ Altered mental status ❑ Cyanosis ❑ Hypotension (MAP <60 mmHg) ❑ Oliguria (<0.5 mL/kg/h) ❑ Tachycardia ❑ Tachypnea

Shock

Resuscitation ❑ 0.5—1 L every 10—15 minutes† ❑ ± Morphine 2—4 mg boluses ❑ Ventilatory support Labs & Imaging ❑ CBC/DC/SMA-7/PT/PTT ❑ Arterial blood gas ❑ Lactate ❑ ECG ❑ CXR ❑ Echocardiography ❑ CXR ❑ Central venous catheter ❑ Pulmonary artery catheter Immediate Goals ❑ MAP >60—65 mmHg ❑ CVP 8—12 mmHg ❑ PCWP 12—15 mmHg ❑ CI >2.1 L/min/m2 ❑ Hemoglobin >7—9 g/dL ❑ SaO2 >90%—92% ❑ MVO2 >60% ❑ SCVO2 >70% ❑ Lactate <2.2 mM/L ❑ Urine output >0.5 mL/kg/h

^† 100—200 mL boluses for cardiogenic shock