Undifferentiated shock

Definition

1. SBP <90 in nl pt
2. SBP<100 with h/o HTN or age >60
3. ABG = lactate > 4 or base def < -4
4. MAP = SVR x CO

Types

Type	Skin	HR	Oth
Hypovolemic	cold	inc
Obstructive	cold	inc
Cardiogenic	cold	inc/dec	?dysth
Anaphylactic	warm	inc	hives
Neurogenic	warm	dec

Undifferentiated Hypotension Algorithm

Check:

1. HR (age appropriate)
   1. <40 and >150-180 --> likely HR = Primary etiology
   2. Pace or Shock
2. Volume Status - LVEDP (approx by CVP, IVC, etc.)
   1. History of volume loss
   2. Lung Exam
   3. Mucous membrane
   4. Ultrasound IVC (RUQ window or AAA)
   5. Hemeacuu, Guaic
3. Contractility (weak heart)
   1. Bounding/thready pulse, hyperdynamic precordium
   2. Cardiac Ultrasound
4. Low SVR - Vasodilation is the final answer, if all else is negative expect bounding pulse

Lack of Response to Normal Tx (DDX)

1. Cardiac tamponade
2. Tension PNTX
3. Adrenal insuffic
4. Toxin
5. Allergic Rx
6. Occult bleeding (ectopic, A/P)
7. PE
8. DIC

Source

2/06 DONALDSON (Adapted from Tintinalli)

Morchi 2010