EM Shock



Shock


Anaphylactic shock

CausesDiagnosisManagement
bee stings
meds
food allergies
CO increased
PVR decreased
PCWP decreased
Give diphenhydramine

If severe, 1:1000 epinephrine

Cardiogenic shock

CausesDiagnosisManagement
CHF
arrhythmia
structural heart disease (severe mitral regurg, VSD)
MI (>40% of left ventricular fxn)
CO decreased
PVR increased
PCWP increased
Identify cause and treat if possible

Give inotropic support w/ pressors such as dopamine (if hypotensive) or dobutamine (if not hypotensive)

Hypovolemic shock

CausesDiagnosisManagement
trauma
blood loss
dehydration w/ inadequate fluid repletion
third spacing
burns
CO decreased
PVR increased
PCWP decreased
replete w/ isotonic solution (LR or NS) and blood in a 3:1 (fluid to blood) ratio

Obstructive shock

CausesDiagnosisManagement
cardiac tamponade
tension pneumothorax
massive PE
CO decreased
PVR increased
PCWP increased
tx the underlying cause:
– pericardiocentesis
– decompression of pneumothorax, thrombolysis

Septic shock

CausesDiagnosisManagement
bacteremia (esp gram neg organisms)CO increased
PVR decreased
PCWP decreased
administer broad spectrum abx
measure CVP and give fluid until CVP= 8

Give pressors (dopamine or norepinephrine)
Obtain cultures prior to admin of abx if possible