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

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