Shock
Anaphylactic shock
Causes | Diagnosis | Management |
bee stings meds food allergies | CO increased PVR decreased PCWP decreased | Give diphenhydramine If severe, 1:1000 epinephrine |
Mikael Häggström / CC0
Cardiogenic shock
Causes | Diagnosis | Management |
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
Causes | Diagnosis | Management |
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
Causes | Diagnosis | Management |
cardiac tamponade tension pneumothorax massive PE | CO decreased PVR increased PCWP increased | tx the underlying cause: – pericardiocentesis – decompression of pneumothorax, thrombolysis |
Septic shock
Causes | Diagnosis | Management |
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 |