Shock resident survival guide

Sepsis Microchapters
Home
Patient Information (Adult)
Patient Information (Neonatal)
Overview
Pathophysiology
Causes
Differentiating Sepsis from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Shock resident survival guide On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Shock resident survival guide All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Shock resident survival guide
CDC on Shock resident survival guide
Shock resident survival guide in the news
Blogs on Shock resident survival guide
Directions to Hospitals Treating Sepsis
Risk calculators and risk factors for Shock resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Zaghw, M.D. [2]

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.

• Anaphylaxis
• Neurogenic 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 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

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