Sandbox/00001: Difference between revisions
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| align="center" style="background: #A8A8A8; width: 55px;"|'''Echocardiographic Findings''' | | align="center" style="background: #A8A8A8; width: 55px;"|'''Echocardiographic Findings''' | ||
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC; width: 80px;" align=center rowspan=3 |'''Cardiogenic'''|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC; width: 20%;" |'''[[Ventricular septal defect|Acute Ventricular Septal Defect]]'''|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↓↓|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |N — ↑|| style="font-size: 90%; padding: 0 5px; background:#DCDCDC;" align=center |↑↑|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑ — ↑↑ || style="font-size: 90%; padding: 0 5px; background: #DCDCDC; width: 20%;" rowspan=3 | Large ventricles | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC; width: 80px;" align=center rowspan=3 |'''Cardiogenic'''|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC; width: 20%;" |'''[[Ventricular septal defect|Acute Ventricular Septal Defect]]'''|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↓↓|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |N — ↑|| style="font-size: 90%; padding: 0 5px; background:#DCDCDC;" align=center |↑↑|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑ — ↑↑ || style="font-size: 90%; padding: 0 5px; background: #DCDCDC; width: 20%;" rowspan=3 | Large ventricles with poor contractility | ||
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" |'''[[Mitral regurgitation|Acute Mitral Regurgitation]]'''|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↓↓|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑↑|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑ — ↑↑|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↓ | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" |'''[[Mitral regurgitation|Acute Mitral Regurgitation]]'''|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↓↓|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑↑|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑ — ↑↑|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↓ | ||
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" |'''[[Myocardial infarction|Myocardial Infarction]]'''|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↓↓|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑||style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑↑|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑↑|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↓ | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" |'''[[Myocardial infarction|Myocardial Infarction]]'''|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↓↓|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑||style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑↑|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑↑|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↓ | ||
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| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" rowspan=2 align=center |'''Obstructive'''|| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" |'''[[Pulmonary embolism|Pulmonary Embolism]]'''|| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↓↓|| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↑|| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |N — ↓|| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↑↑||style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↓||style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=left |Dilated | | style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" rowspan=2 align=center |'''Obstructive'''|| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" |'''[[Pulmonary embolism|Pulmonary Embolism]]'''|| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↓↓|| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↑|| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |N — ↓|| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↑↑||style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↓||style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=left |Dilated RV, small LV | ||
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| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" |'''[[Cardiac tamponade|Cardiac Tamponade]]'''|| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↓ — ↓↓|| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↑|| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↑↑|| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↑↑|| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↓||style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=left |Pericardial effusion, small | | style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" |'''[[Cardiac tamponade|Cardiac Tamponade]]'''|| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↓ — ↓↓|| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↑|| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↑↑|| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↑↑|| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=center |↓||style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=left |Pericardial effusion, small ventricles, dilated inferior vena cava | ||
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" rowspan=2 align=center |'''Distributive'''|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" |'''[[Septic shock|Septic Shock]]'''|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |N — ↑↑|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↓ — ↓↓|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |N — ↓|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |N — ↓|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑ — ↑↑||style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left rowspan=2 |Normal cardiac chambers with preserved contractility | | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" rowspan=2 align=center |'''Distributive'''|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" |'''[[Septic shock|Septic Shock]]'''|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |N — ↑↑|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↓ — ↓↓|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |N — ↓|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |N — ↓|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=center |↑ — ↑↑||style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left rowspan=2 |Normal cardiac chambers with preserved contractility |
Revision as of 02:17, 8 April 2014
Shock Resident Survival Guide |
---|
Overview |
Causes |
FIRE |
Approach |
Do's |
Don'ts |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Zaghw, MBChB. [2]
Synonyms and keywords: Circulatory shock
Overview
Shock is the syndrome of circulatory failure that results in inadequate cellular oxygen utilization. The diagnosis of shock is based on clinical signs and biochemical abnormalities indicative of tissue hypoperfusion.[1]
Causes
Life Threatening Causes
Shock is a life-threatening condition and must be treated as such irrespective of the underlying cause.
Common Causes
- Cardiogenic shock
- Arrhythmic
- Mechanical
- Myocardial
- Pharmacologic
- Obstructive shock
- Decreased cardiac compliance
- Decreased ventricular preload
- Increased ventricular afterload
- Hypovolemic shock
- Fluid depletion
- Hemorrhage
- Distributive shock
- Sepsis
- Toxic shock syndrome
- Anaphylactic or anaphylactoid reaction
- Neurogenic shock
- Endocrinologic
Click here for the complete list of causes.
FIRE: Focused Initial Rapid Evaluation
Approach
❑ Altered mental status | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
❑ Intubation with mechanical ventilation | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
❑ CBC/DC/SMA-7/PT/PTT | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
❑ MAP >65–70 mmHg | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Classify and Treat Accodringly | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
† For septic and hypovolemic shock; consider normal saline 100—200 mL boluses for cardiogenic shock.
Classification
Type of Shock | CO | SVR | PCWP | CVP | SVO2 | Echocardiographic Findings | |
Cardiogenic | Acute Ventricular Septal Defect | ↓↓ | ↑ | N — ↑ | ↑↑ | ↑ — ↑↑ | Large ventricles with poor contractility |
Acute Mitral Regurgitation | ↓↓ | ↑ | ↑↑ | ↑ — ↑↑ | ↓ | ||
Myocardial Infarction | ↓↓ | ↑ | ↑↑ | ↑↑ | ↓ | ||
Obstructive | Pulmonary Embolism | ↓↓ | ↑ | N — ↓ | ↑↑ | ↓ | Dilated RV, small LV |
Cardiac Tamponade | ↓ — ↓↓ | ↑ | ↑↑ | ↑↑ | ↓ | Pericardial effusion, small ventricles, dilated inferior vena cava | |
Distributive | Septic Shock | N — ↑↑ | ↓ — ↓↓ | N — ↓ | N — ↓ | ↑ — ↑↑ | Normal cardiac chambers with preserved contractility |
Anaphylactic Shock | N — ↑↑ | ↓ — ↓↓ | N — ↓ | N — ↓ | ↑ — ↑↑ | ||
Hypovolemic | Volume Depletion | ↓↓ | ↑ | ↓↓ | ↓↓ | ↓ | Small cardiac chambers with normal or high contractility |
Do's
- Resuscitation should be initiated while investigation of the cause is ongoing. Correct the cause of shock immediately once it is identified.
Don'ts
References
- ↑ 1.0 1.1 1.2 Vincent, JL.; De Backer, D. (2013). "Circulatory shock". N Engl J Med. 369 (18): 1726–34. doi:10.1056/NEJMra1208943. PMID 24171518. Unknown parameter
|month=
ignored (help) - ↑ Weil, MH.; Shubin, H. (1969). "The VIP approach to the bedside management of shock". JAMA. 207 (2): 337–40. PMID 5818156. Unknown parameter
|month=
ignored (help) - ↑ Dellinger, RP.; Levy, MM.; Rhodes, A.; Annane, D.; Gerlach, H.; Opal, SM.; Sevransky, JE.; Sprung, CL.; Douglas, IS. (2013). "Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012". Crit Care Med. 41 (2): 580–637. doi:10.1097/CCM.0b013e31827e83af. PMID 23353941. Unknown parameter
|month=
ignored (help) - ↑ Parrillo, Joseph E.; Ayres, Stephen M. (1984). Major issues in critical care medicin. Baltimore: William Wilkins. ISBN 0-683-06754-0.
- ↑ Weil, Max Harry; Shubin, Herbert (1967). Diagnosis and Treatment of Shock. Williams & Wilkins. ISBN 1125885874.