Undifferentiated shock

Definition

SBP <90 in nl pt

SBP<100 with h/o HTN or age >60

ABG = lactate > 4 or base def < -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

• • PE: no response to IVF, nmlly hypoxic if large enough to cause shock

Undifferentiated Hypotension Algorithm (Morchi)

Check:

1) HR (age appropriate)

    <40 and >150-180 --> likely HR = Primary etiology

    Pace or Shock

2) Volume Status - LVEDP (approx by CVP, IVC, etc.)

    History of volume loss

    Lung Exam

    Mucous membrane

    Ultrasound IVC (RUQ window or AAA)

    Hemeacuu, Guaic

3) Contractility (weak heart)

    Bounding/thready pulse, hyperdynamic precordium

    Cardiac Ultrasound

4) Low SVR - Vasodilation is the final answer, if all else is negative

    expect bounding pulse

Adapted from Morchi

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