Related Subjects:
Atropine
| Acute Anaphylaxis
| Basic Life Support
| Advanced Life Support
| Adrenaline/Epinephrine
|Acute Hypotension
|Cardiogenic shock
|Distributive Shock
|Hypovolaemic or Haemorrhagic Shock
|Obstructive Shock
|Septic Shock and Sepsis
|Shock (General Assessment)
|Toxic Shock Syndrome
|Respiratory Failure
|Non invasive ventilation (NIV)
|Intubation and Mechanical Ventilation
|Critical illness neuromuscular weakness
|Multiple Organ Dysfunction Syndrome
A patient with a palpable radial pulse indicates a SBP of at least 80 mmHg, and a palpable femoral pulse indicates SBP of at least 70 mmHg.
| Initial Shock Management: Oxygen 15 L/min unless COPD. NS= N-Saline |
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Shock’ exists when oxygen delivery fails to meet the metabolic requirements of the tissues. Shock is not equal to hypotension, but hypotension may be a late manifestation of circulatory failure with failure to deliver oxygen to tissues
Introduction
- Acute circulatory collapse with evidence of insufficient end-organ perfusion.
- There are multiple causes of shock which affect the onset and presentation.
- Shock is due to low Cardiac output or a loss of Systemic vascular resistance or both
Clinical features of shock
- Tachypnoea: Rapid, shallow respiration
- Tachycardia (> 100/min)
- Hypotension (systolic BP < 100 mmHg)
- Drowsiness, confusion, irritability
- Oliguria (urine output <0.5 mL/hr/kg)
- Multi-organ failure
- Vasodilated shock: Warm peripheries, Low diastolic BP
- Hypovolaemic shock: Cold, clammy skin
Classification
- Cardiogenic: MI, Myocarditis, Endocarditis
- Obstructive: PE , Tamponade, tension PTX
- Septic: Uro/Chest/Abdominal other
- Anaphylactic: bee sting, nuts
- Hypovolaemic/Haemorrhagic: GI bleed, Trauma
- Neurogenic: spinal injury
Severity
Clinical Indicators of possible aetiology
- Chest pain: MI (cardiogenic shock or acute MR), Aortic dissection, PE
- Breathless, Cyanosis: LVF, Pneumothorax and tamponade, Acute severe asthma
- Haemoptysis, Melena: GI bleed needs endoscopy
- Pelvic or femur fracture: local bleed or fat embolism or PE
- Fever, malaise, cough, sputum, low neutrophils, immunocompromised: Sepsis
- Abdominal pain: Perforation and sepsis, Leaking AAA
- Severe breathless with Ketones on the breath: DKA needs fluids/potassium and Insulin
- Pregnancy and abdominal pain: Ectopic pregnancy. check beta-HCG get USS
- Retained Tampon: Toxic shock syndrome
- Recent immobility: PE needs anticoagulation
- Pigmented: Addison's disease. Low Na, High K needs steroids
- Non-blanching rash: Meningococcal septicaemia needs Antibiotics
Investigations
- FBC: elevated or low WCC with sepsis. Low HB with bleed
- U&E: often AKI
- Glucose; High with DKA, HHS
- Lactate often elevated
- Troponin elevated in MI
- Dimer elevated in PE
- CXR: consolidation and sepsis, widened mediastinum in aortic dissection, LVF
- Cortisol: Addison (treat if suspicious as the diagnosis can be made later)
Management
- ABC, Get good Venous access
- Treat likely cause and get expert advice early