Sandbox/00001

Sandbox/00001 Resident Survival Guide Microchapters
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

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

Synonyms and keywords: Circulatory shock

Overview

Causes

Life Threatening Causes

Sandbox/00001 is a life-threatening condition and must be treated as such irrespective of the underlying cause.

Common Causes

Click here for the complete list of causes.

FIRE: Focused Initial Rapid Evaluation

A Focused Initial Rapid Evaluation (FIRE) as shown below should be performed to identify patients in need of immediate intervention.

Boxes in red signify that an urgent management is needed.

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

Complete Diagnostic Approach

Treatment

Do's

Don'ts

References

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