approach to the patient in shock n.
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Approach to the patient in shock
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  1. Approach to the patient in shock

  2. Epidemiology and mortality • Approximately one million cases per year • Septic: 40-60% mortality • Cardiogenic: 36-56% mortality

  3. pathophys • Shock is circulatory insufficiency that creates an imbalance between tissue oxygen supply (delivery) and oxygen demand (consumption • Leads to a reduction in effective tissue perfusion with its attendant biochemical, bioenergetic, and subcellular sequelae

  4. Pathophys, cont’d • When compensatory mechanisms fail to correct the imbalance between tissue supply and demand, anaerobic metabolism occurs, resulting in the formation of lactic acid.

  5. Clinical features • weakness, lethargy, or altered mental status • bleeding, vomiting, diarrhea, excessive urination • Table 25.4 gives complete physical exam findings in shock • Shock index: HR/SBP • Normal is .5 - .7

  6. diagnosis

  7. Labs and imaging • Sepsis panel • CXR • Ultrasound • IVC compressibility

  8. treatment • Early Goal Directed Therapy • ABCDE • A goal-directed approach of • urine output >0.5 mL/kg/h • CVP 8 to12 mm Hg • MAP 65 to 90 mm Hg • ScvO2 >70% during ED resuscitation of septic shock significantly decreases mortality

  9. Resources • Tintinalli Ch. 25