Sandbox/00002

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 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 ❑ MAP >65–70 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

Classify and treat accodringly

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