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Shock

Diagnose Shock

  • ↑ HR >100 bpm
  • ↓ BP
  • altered mental status
  • RR >20/min
  • base deficit < -4mEq/L OR eeleavted lactate
  • Urine < 0.5ml/kg/hr

Shock Presentation

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Identify the causses

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Types of Shock by mNG

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Initial Mang of Shock

alt text - 30ml/kg fluids

  • then based on Cause of Shock

  • IV vaso-modualtors

    • Cardiogenic shock[ by Mi ,arrythmia ]

    • Dobuatamine β1 , β2 > α1 agonist [ ↑CO,↓SVR] REDUCE HEART STRESS in PUMPING and Perfusion to organs

    • Nor-ad [↑CO,⇑SVR ]

    • Septic shock - vasodilation from anti-inflammatory

    • 30ml/kg fluids

    • Septic Shock antibiotics
    • Nor-ad [↑SVR,↑ CO]
    • vassopressin
    • dopamine [↑CO ]

    • Anaphylaxis

    • Epinephrine[ ↑CO,↑TPR, Bronchodialtion]

    • Trauma/Hemorrhage

    • pulmonary causes
    • cardiac tamponade
    • 30ml/kg
    • PRBC Transfusion

    • Hypotension with Bradycardia

    • thyroid test
    • Steroid Withdrawl - Single dose Steroid
    • iontoropic antagonist poisoning - anti-dotes

when to Stop Fluid Resusciatation

- Urine output = 0.5ml/kg/hr 
- BP to normal
- Low Lactate levels