Shock Diagnosis and Management Overview

III appearance or altered mental status, heart rate >100 beats/min, respiratory rate >20 breaths/min or Paco2 <32 mm Hg, arterial base deficit <-4 mEq/L or lactate level >4 mM/L, urine output <0.5 mL/kg/h, arterial hypotension >30 min duration, continuous.

Rapid recognition is crucial for timely assessment and treatment of shock to prevent worsening of the condition, even before identifying the exact cause.

Worsening base deficit, lactic acidosis, stress response (ill appearance, pale, asthenic, sweating, tachypneic), weak and rapid pulse.

<p>Noninvasive measurement of BP might be inaccurate in severe hypotensive states, and compensatory adrenergic reflexes may keep BP normal initially.</p> Signup and view all the answers

<p>Measurement of urine output, assessment of mental status, tests for liver or coagulation impairment, lactate concentration, and base deficit evaluation.</p> Signup and view all the answers

<p>It indicates severe circulatory insufficiency that could lead to multiple organ failure and is predictive of patient outcomes.</p> Signup and view all the answers

<p>Ensure adequate ventilation, control hemorrhage, initiate infusion of isotonic crystalloid, and start PRBC infusion if needed.</p> Signup and view all the answers

<p>Septic shock is defined as sepsis plus hypotension requiring vasopressors after fluid loading and a lactate level &gt;2 mmol/L.</p> Signup and view all the answers

<p>Ameliorate increased work of breathing, provide oxygen and PEEP, initiate vasopressor or inotropic support, and attempt to reverse the insult.</p> Signup and view all the answers

<p>Resuscitating patients to predefined physiologic endpoints to ensure systemic perfusion and restore vital organ function, often within the first 6 hours.</p> Signup and view all the answers

<p>Intraosseous (IO) access should be established for temporary administration of fluids and medications.</p> Signup and view all the answers

<p>It's used to monitor systemic perfusion and evaluate the adequacy of resuscitation efforts, aiming for a reduction of lactate concentration by 10% to 20%.</p> Signup and view all the answers

<p>Initiate PRBC infusion if there's evidence of poor organ perfusion and expected hemorrhage control delay or if massive hemorrhage is suspected.</p> Signup and view all the answers

<ul> <li>Ensure adequate oxygenation, administer crystalloids, begin antimicrobial therapy, consider surgical drainage, and start vasopressor support if necessary.</li> </ul> Signup and view all the answers

<p>Further steps to improve systemic perfusion should be undertaken, such as adjusting fluid therapy or vasopressor support.</p> Signup and view all the answers

<p>BP can be normal initially due to compensatory adrenergic reflexes, and HR may be normal or low. These metrics correlate poorly with cardiac index (CI) and systemic hypoperfusion.</p> Signup and view all the answers

<p>Arterial or venous lactate concentration and base deficit. Lactate &gt;4 mM or base deficit &lt;−4 mEq/L indicate severe circulatory insufficiency.</p> Signup and view all the answers

<p>Muffled heart sounds with jugular venous distention.</p> Signup and view all the answers

<p>Chest X-ray, ECG, CBC, urinalysis, electrolytes, kidney/liver function tests, ABG (for base deficit and lactate), and bedside ultrasound (cardiac/abdominal).</p> Signup and view all the answers

<p>Sepsis (suspected infection + SOFA score increase ≥2) plus hypotension requiring vasopressors after fluid resuscitation and lactate &gt;2 mmol/L.</p> Signup and view all the answers

<p>Hemorrhagic shock requires meeting ≥4 criteria from Box 3.2 (e.g., lactic acidosis, organ dysfunction). Simple hemorrhage involves normal BP, HR, respiratory rate, and base deficit.</p> Signup and view all the answers

<p>Administer 30 mL/kg crystalloid, titrate based on dynamic indices, volume responsiveness, or urine output.</p> Signup and view all the answers

<p>When peripheral or central venous access cannot be rapidly obtained. IO allows temporary administration of fluids/medications.</p> Signup and view all the answers

<p>Oxygen/PEEP for pulmonary edema, vasopressors/inotropes (e.g., norepinephrine, dobutamine), reversing the cause (e.g., thrombolysis), and considering intra-aortic balloon pump.</p> Signup and view all the answers

<p>It is equivalent to central venous oxygen saturation as a perfusion marker, can be measured peripherally, and a 10-20% decrease within 2 hours indicates adequate resuscitation.</p> Signup and view all the answers

<p>Hypotension, tachycardia, low cardiac output, dusky/mottled skin, delayed capillary refill, altered mental status, low urine output, low central venous oxygen saturation, elevated lactate.</p> Signup and view all the answers

<p>CMS uses 2001 criteria: ≥2 SIRS criteria + end-organ dysfunction. Sepsis-3 removes SIRS and relies on SOFA score.</p> Signup and view all the answers

<p>They improve BP monitoring accuracy, especially with vasoactive medications, and allow measurement of dynamic variables (e.g., stroke volume variation).</p> Signup and view all the answers

<p>If central/IO access is unavailable, use a large-gauge (≥18g) peripheral catheter at the antecubital fossa or proximal site.</p> Signup and view all the answers

<p>Immediate hemorrhage control (e.g., direct pressure, REBOA), judicious crystalloid (10–20 mL/kg), and PRBC transfusion if perfusion remains poor or hemorrhage is massive.</p> Signup and view all the answers

<p>It reflects vital organ perfusion. Normal output is &gt;1.0 mL/kg/h; &lt;0.5 mL/kg/h indicates severe hypoperfusion (except in preexisting renal disease).</p> Signup and view all the answers

<p>Hyperdynamic left ventricular function in undifferentiated shock.</p> Signup and view all the answers

<p>It is associated with up to fourfold higher in-hospital mortality, regardless of cause.</p> Signup and view all the answers

<p>A 10-20% decrease in lactate within 2 hours of initiating treatment. Failure to clear suggests need for further intervention.</p> Signup and view all the answers

Ill appearance, heart rate >100 bpm, respiratory rate >20 breaths/min, or base deficit >2 mmol/L.

Focus on reducing work of breathing, provide oxygen and PEEP, initiate vasopressors/inotropes, and reverse the cause.

Resuscitate to predefined physiologic endpoints to restore organ function within 6 hours.

Use IO access when oral or IV access is not feasible for fluids and medications.

Monitors systemic perfusion; aims for a 10%-20% reduction during resuscitation.

Start PRBC if evidence of poor perfusion and expected delay in hemorrhage control or suspect massive hemorrhage.

Ensure oxygenation, administer crystalloids, initiate antimicrobials, consider drainage, and start vasopressors if needed.

If lactate clearance is inadequate, improve systemic perfusion through fluid or vasopressor adjustments.

Administer 30 mL/kg of crystalloids, adjusting based on responsiveness.

Use intraosseous access when rapid peripheral or central venous access can't be obtained.

Focus on oxygen therapy, vasopressors/inotropes, reversing cause, and possibly using intra-aortic balloon pump.

Lactate decrease reflects perfusion improvement, similar to central venous oxygen saturation.

Look for hypotension, tachycardia, altered mental status, low urine output, or mottled skin.

Defines severe sepsis using SIRS criteria and end-organ dysfunction.

Allows accurate BP monitoring and measures dynamic variables with vasoactive medications.

Use large-gauge peripheral IV (≥18g) when central/IO access isn't available.

Control hemorrhage, give crystalloid (10–20 mL/kg), and PRBC if perfusion remains poor.

Normal urine output (>1.0 mL/kg/h) indicates effective organ perfusion.