Sandbox/001

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Circulatory shock

Definition

Shock is the clinical expression of circulatory failure that results in inadequate cellular oxygen utilization.

Causes

Shock is a life-threatening condition and must be treated as such irrespective of the causes.

Classification

Hemodynamic Profiles of Shock

Type of Shock		CO	SVR	PCWP	CVP	SVO2
Cardiogenic	Acute Ventricular Septal Defect	↓↓	↑	N — ↑	↑↑	↑ — ↑↑
	Acute Mitral Regurgitation	↓↓	↑	↑↑	↑ — ↑↑	↓
	Myocardial Infarction	↓↓	↑	↑↑	↑↑	↓
Obstructive	Pulmonary Embolism	↓↓	↑	N — ↓	↑↑	↓
	Cardiac Tamponade	↓ — ↓↓	↑	↑↑	↑↑	↓
Distributive	Septic Shock	N — ↑↑	↓ — ↓↓	N — ↓	N — ↓	↑ — ↑↑
	Anaphylactic Shock	N — ↑↑	↓ — ↓↓	N — ↓	N — ↓	↑ — ↑↑
Hypovolemic	Volume Depletion	↓↓	↑	↓↓	↓↓	↓

Management

Symptoms & Signs ❑ Altered mental status ❑ Cyanosis ❑ Hypotension (MAP <60 mmHg) ❑ Oliguria (<0.5 mL/kg/h) ❑ Tachycardia ❑ Tachypnea

Shock

Resuscitation ❑ Ventilatory support ❑ Morphine 2—4 mg boluses ❑ 0.5—1 L every 10—15 minutes† Immediate Goals ❑ MAP >60—65 mmHg ❑ CVP 8—12 mmHg ❑ PCWP 12—15 mmHg ❑ CI >2.1 L/min/m2 ❑ Hemoglobin >7—9 g/dL ❑ SaO2 >90%—92% ❑ MVO2 >60% ❑ SCVO2 >70% ❑ Lactate <2.2 mM/L ❑ Urine output >0.5 mL/kg/h

Labs & Imaging ❑ CBC/DC/SMA-7/PT/PTT ❑ Arterial blood gas ❑ Lactate ❑ ECG ❑ Echocardiography

^† 100—200 mL boluses for cardiogenic shock