Sandbox/00002: Difference between revisions

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Revision as of 01:47, 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)^[1]^[2]

❑ Intubation with mechanical ventilation
❑ Normal saline 0.5–1 L 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
❑ Central venous catheter

❑ Pulmonary artery catheter

Immediate Goals^[3]

❑ MAP >65–70 mmHg
❑ CVP 8–12 mmHg
❑ PCWP 12–15 mmHg
❑ CI >2.1 L/min/m²
❑ Sa_O₂ >90%–92%
❑ M_VO₂ >60%
❑ S_CVO₂ >70%
❑ Hemoglobin >7–9 g/dL
❑ Lactate <2.2 mM/L

❑ Urine output >0.5 mL/kg/h

Classify and treat accodringly

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

References

↑ 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)
↑ 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)
↑ 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)

[Weil-1969-1] 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)

[Vincent-2013-2] 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)

[Dellinger-2013-3] 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)

[1]

[2]

[3]

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 {{Family tree|border=2|boxstyle=background: #FA8072; color: #F8F8FF; line-height: 20px; padding: 5px; text-align: left; height: 100px;              | | | | | | | | | | | | | B03 | | | | | | | | | | | | | |B03=
-<center>'''Ventilate—Infuse—Pump (VIP)'''</center>
+<center>'''Ventilate—Infuse—Pump (VIP)'''<ref name="Weil-1969">{{Cite journal  | last1 = Weil | first1 = MH. | last2 = Shubin | first2 = H. | title = The VIP approach to the bedside management of shock. | journal = JAMA | volume = 207 | issue = 2 | pages = 337-40 | month = Jan | year = 1969 | doi =  | PMID = 5818156 }}</ref><ref name="Vincent-2013">{{Cite journal | last1 = Vincent | first1 = JL. | last2 = De Backer | first2 = D. | title = Circulatory shock. | journal = N Engl J Med | volume = 369 | issue = 18 | pages = 1726-34 | month = Oct | year = 2013 | doi = 10.1056/NEJMra1208943 | PMID = 24171518 }}</ref>
+</center>
 ----
 ❑ Intubation with mechanical ventilation<br>
@@ Line 32: / Line 34: @@
 {{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: 260px;              | | | | | | | | | | | | | B05 | | | | | | | | | | | | | |B05=
-<center>'''Immediate Goals'''</center>
+<center>'''Immediate Goals'''<ref name="Dellinger-2013">{{Cite journal  | last1 = Dellinger | first1 = RP. | last2 = Levy | first2 = MM. | last3 = Rhodes | first3 = A. | last4 = Annane | first4 = D. | last5 = Gerlach | first5 = H. | last6 = Opal | first6 = SM. | last7 = Sevransky | first7 = JE. | last8 = Sprung | first8 = CL. | last9 = Douglas | first9 = IS. | title = Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. | journal = Crit Care Med | volume = 41 | issue = 2 | pages = 580-637 | month = Feb | year = 2013 | doi = 10.1097/CCM.0b013e31827e83af | PMID = 23353941 }}</ref></center>
 ----
 ❑ MAP >65–70 mmHg<br>
@@ Line 50: / Line 52: @@
 <sup>†</sup> For septic and hypovolemic shock; consider normal saline 100—200 mL boluses for cardiogenic shock.
-==Classification==
 ==References==
 {{reflist|2}}
-<!--
-SSC
-<ref name="Dellinger-2013">{{Cite journal  | last1 = Dellinger | first1 = RP. | last2 = Levy | first2 = MM. | last3 = Rhodes | first3 = A. | last4 = Annane | first4 = D. | last5 = Gerlach | first5 = H. | last6 = Opal | first6 = SM. | last7 = Sevransky | first7 = JE. | last8 = Sprung | first8 = CL. | last9 = Douglas | first9 = IS. | title = Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. | journal = Crit Care Med | volume = 41 | issue = 2 | pages = 580-637 | month = Feb | year = 2013 | doi = 10.1097/CCM.0b013e31827e83af | PMID = 23353941 }}</ref>
--->

Sandbox/00002: Difference between revisions

Revision as of 01:47, 8 April 2014

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