Shock resident survival guide: Difference between revisions
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== | ==Overview== | ||
Shock is a condition in which blood flow to the organs is reduced due to either a low volume of blood, poor forward pumping by the heart, or redistribution of fluids out of the vascular space. | |||
==Causes== | ==Causes== | ||
Revision as of 11:11, 13 March 2014
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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]
Overview
Shock is a condition in which blood flow to the organs is reduced due to either a low volume of blood, poor forward pumping by the heart, or redistribution of fluids out of the vascular space.
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
- True hypovolemia
- Bleeding i.e hemorrhagic shock
- Fluid loss (e.g. diarrhoea, vomiting, bowel obstruction, 'third' spacing)
- Redistributive shock
- Relative hypovolemia
- Obstructive shock
- The flow of blood is obstructed which impedes circulation and can result in circulatory arrest
- Cardiac tamponade
- Constrictive pericarditis
- Tension pneumothorax
- Massive pulmonary embolism
- Aortic stenosis by compromising ventricular outflow tract
- Endocrine shock
- Hypothyroidism reduces cardiac output and may cause hypotension and respiratory insufficiency
- Thyrotoxicosis may induce a reversible cardiomyopathy
- Acute adrenal insufficiency due to discontinuing corticosteroid without tapering
- 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 | |||||||||||||||||||||||||||