Epidemiology and mortality • Approximately one million cases per year • Septic: 40-60% mortality • Cardiogenic: 36-56% mortality
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
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.
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
Labs and imaging • Sepsis panel • CXR • Ultrasound • IVC compressibility
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
Resources • Tintinalli Ch. 25