#EMconf: Shock Pearls from Dr. Mallemat
Thu, 03/23/2017 - 6:04am
Pearls When Approaching a Patient with Undifferentiated Shock:
- Shock is defined as circulatory dysfunction that leads to inadequate tissue / organ perfusion; the goal during resuscitation is to correct abnormal perfusion.
- There are three components to tissue / organ perfusion: the pump (i.e., heart), the pipes (i.e., mean arterial pressure) and the tank (i.e., intravascular volume)
- There are four categories of shock: 1) hypovolemic, 2) Obstructive, 3) Cardiogenic, 4) Distributive; each one of these classes affects the pump, pipes, and tank differently.
- Because not all presentations of shock are obvious use the ultrasound to evaluate the pump, pipes, and tank. Then target your resuscitation to the specific component that needs help.
- Other tips for resuscitation:
- During large volume resuscitation, consider LR over normal saline as there are more adverse events with normal saline (e.g., renal injury).
- Always examine your patient's feet! Warm feet = warm shock and Cold feet = cold shock.
- Have a low threshold for placing an A-line for hemodynamic monitoring and strongly consider the femoral site over radial (easier, faster, and more accurate)
- Methylene blue can be considered for patients in vasopressor refractory septic shock (i.e., adequate IV fluids and requiring multiple vasopressors)