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<center>'''Shock'''</center>}}
<center>'''Shock'''</center>}}
{{Family tree|border=2|boxstyle=background: #FA8072; color: #F8F8FF; line-height: 10px; padding: 5px; text-align: left;                            | | | | | | | | | | | | | |!| | | | | | | | | | | | | | |}}
{{Family tree|border=2|boxstyle=background: #FA8072; color: #F8F8FF; line-height: 10px; padding: 5px; text-align: left;                            | | | | | | | | | | | | | |!| | | | | | | | | | | | | | |}}
{{Family tree|border=2|boxstyle=background: #FA8072; color: #F8F8FF; line-height: 20px; padding: 5px; text-align: left; height: 180px;              | | | | | | | | | | | | | B03 | | | | | | | | | | | | | |B03=
{{Family tree|border=2|boxstyle=background: #FA8072; color: #F8F8FF; line-height: 20px; padding: 5px; text-align: left; height: 100px;              | | | | | | | | | | | | | B03 | | | | | | | | | | | | | |B03=
<center>'''Ventilate'''</center>
<center>'''Ventilate—Infuse—Pump (VIP)'''</center>
----
----
❑ Intubation with mechanical ventilation<br>
❑ Intubation with mechanical ventilation<br>
<center>'''Infuse'''</center>
❑ Normal saline 500–1000 mL q10–15 min<sup>†</sup><br>
----
❑ Normal saline 500–1000 mL q10–15 minutes<sup>†</sup><br>
<center>'''Pump'''</center>
----
❑ Norepinephrine 0.1–2.0 μg/kg/min}}
❑ Norepinephrine 0.1–2.0 μg/kg/min}}
{{Family tree|border=2|boxstyle=background: #FA8072; color: #F8F8FF; line-height: 10px; padding: 5px; text-align: left;                            | | | | | | | | | | | | | |!| | | | | | | | | | | | | | |}}
{{Family tree|border=2|boxstyle=background: #FA8072; color: #F8F8FF; line-height: 10px; padding: 5px; text-align: left;                            | | | | | | | | | | | | | |!| | | | | | | | | | | | | | |}}
{{Family tree|border=2|boxstyle=background: #FA8072; color: #F8F8FF; line-height: 20px; padding: 5px; text-align: left; height: 180px;              | | | | | | | | | | | | | B04 | | | | | | | | | | | | | |B04=
{{Family tree|border=2|boxstyle=background: #FA8072; color: #F8F8FF; line-height: 20px; padding: 5px; text-align: left; height: 200px;              | | | | | | | | | | | | | B04 | | | | | | | | | | | | | |B04=
<center>'''Workups'''</center>
<center>'''Workups'''</center>
----
----
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❑ CXR<br>
❑ CXR<br>
❑ Central venous catheter<br>
❑ Central venous catheter<br>
❑ Pulmonary artery catheter<br>}}
❑ Pulmonary artery catheter}}
{{Family tree|border=2|boxstyle=background: #FA8072; color: #F8F8FF; line-height: 10px; padding: 5px; text-align: left;                            | | | | | | | | | | | | | |!| | | | | | | | | | | | | | |}}
{{Family tree|border=2|boxstyle=background: #FA8072; color: #F8F8FF; line-height: 10px; padding: 5px; text-align: left;                            | | | | | | | | | | | | | |!| | | | | | | | | | | | | | |}}
{{Family tree|border=2|boxstyle=background: #FA8072; color: #F8F8FF; line-height: 20px; padding: 5px; text-align: left; height: 180px;              | | | | | | | | | | | | | B05 | | | | | | | | | | | | | |B05=
{{Family tree|border=2|boxstyle=background: #FA8072; color: #F8F8FF; line-height: 12px; padding: 5px; text-align: left; height: 180px;              | | | | | | | | | | | | | B05 | | | | | | | | | | | | | |B05=
<center>'''Immediate Goals'''</center>
<center>'''Immediate Goals'''</center><br>
----
----
❑ MAP >60–65 mmHg<br>
❑ MAP >60–65 mmHg<br>
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❑ PCWP 12–15 mmHg<br>
❑ PCWP 12–15 mmHg<br>
❑ CI >2.1 L/min/m<sup>2</sup><br>
❑ CI >2.1 L/min/m<sup>2</sup><br>
❑ SaO<sub>2</sub> >90%–92%<br>
❑ MVO<sub>2</sub> >60%<br>
❑ SCVO<sub>2</sub> >70%<br>
❑ Hemoglobin >7–9 g/dL<br>
❑ Hemoglobin >7–9 g/dL<br>
❑ SaO2 >90%–92%<br>
❑ MVO2 >60%<br>
❑ SCVO2 >70%<br>
❑ Lactate <2.2 mM/L<br>
❑ Lactate <2.2 mM/L<br>
❑ Urine output >0.5 mL/kg/h}}
❑ Urine output >0.5 mL/kg/h}}

Revision as of 00:56, 8 April 2014


 
 
 
 
 
 
 
 
 
 
 
 
Symptoms & Signs

❑ Altered mental status
❑ Clammy skin ± cyanosis
❑ Hypotension (MAP <70 mmHg)
❑ Oliguria (urine output <0.5 mL/kg/h)

❑ Tachycardia (heart rate >100 bpm)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Shock
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ventilate—Infuse—Pump (VIP)

❑ Intubation with mechanical ventilation
❑ Normal saline 500–1000 mL q10–15 min†

❑ Norepinephrine 0.1–2.0 μg/kg/min
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Workups

❑ CBC/DC/SMA-7/PT/PTT
❑ Arterial blood gas
❑ Lactate
❑ ECG
❑ CXR
❑ Echocardiography
❑ CXR
❑ Central venous catheter

❑ Pulmonary artery catheter
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Immediate Goals

❑ MAP >60–65 mmHg
❑ CVP 8–12 mmHg
❑ PCWP 12–15 mmHg
❑ CI >2.1 L/min/m2
❑ SaO2 >90%–92%
❑ MVO2 >60%
❑ SCVO2 >70%
❑ Hemoglobin >7–9 g/dL
❑ Lactate <2.2 mM/L

❑ Urine output >0.5 mL/kg/h
 
 
 
 
 
 
 
 
 
 
 
 
 


† For septic and hypovolemic shock; consider normal saline 100—200 mL boluses for cardiogenic shock.

References


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