D. P. Laporta MD SMBD-JGH Dept of Adult Critical Care
D. P. Laporta MD SMBD-JGH Dept of Adult Critical Care
D. P. Laporta MD SMBD-JGH Dept of Adult Critical Care
Laporta MD
SMBD-JGH
Dept of Adult Critical Care
SHOCK - OUTLINE
DEFINITION
CAUSES
EFFECTS
OF INEFFECTIVE TREATMENT
ASSESSMENT
CLINICAL APPROACH
CASE
CASE
CASE
CASE
CASE
CASE
SHOCK CASES
SHOCK DEFINITION
CAUSES
EFFECTS OF INEFFECTIVE TREATMENT
ASSESSMENT
CLINICAL APPROACH
DEFINITION
SHOCK
DEFINITION
CAUSES
HYPOPERFUSED STATES
RV
Venous
PVR
(capacitance)
LV
Arterial
(resistance)
EF End-Diastolic Volume
SVR
BP 60/30
Hypovolemic
HR 140/min
CVP 0
Lactate 10
Cardiogenic
BP 70/50
HR 130/min
CVP 18
Lactate 12
Obstructive
BP 70/50
HR 140/min
CVP 15
Lactate 12
VTED
OAD
DLD
Distributive
BP 70/40
HR 140/min
CVP 5
Lactate 12
SHOCK
DEFINITION
CAUSES
EFFECTS
OF INEFFECTIVE TREATMENT
ASSESSMENT
MEASUREMENT
CLINICAL APPROACH
MISERY !!!
MODS
PO2/FiO2 ratio
Serum creatinine
Platelet count
Glasgow coma score
Serum bilirubin
Pressure-adjusted heart rate
(hr x CVP/MAP)
INFECTION
SHOCK
DEFINITION
CAUSES
EFFECTS OF INEFFECTIVE TREATMENT
ASSESSMENT
MEASUREMENT
CLINICAL APPROACH
SHOCK: asssessment
Class 1&2
vs 3&4
needs blood or crystalloid ?
Sublingual capnometry:
A new noninvasive measurement for diagnosis and
quantitation of severity of circulatory shock
Max Harry Weil MD, PhD, FCCM - CCM 1999
Sublingual capnometry:
A new noninvasive measurement for diagnosis and
quantitation of severity of circulatory shock
Sublingual capnometry:
A new noninvasive measurement for diagnosis and
quantitation of severity of circulatory shock
Sublingual capnometry:
A new noninvasive measurement for diagnosis and
quantitation of severity of circulatory shock
P SL CO2 provides
a prompt
indication of the
reversal of tissue
hypercarbia
when circulatory
shock is reversed
SHOCK
DEFINITION
CAUSES
EFFECTS OF IEFFECTIVE TREATMENT
MEASUREMENT
CLINICAL
APPROACH
GOAL:
RAPIDLY RESTORE TISSUE PERFUSION
Recognize it !!!
Management priorities
in hypoperfused states
Volume
Fluids
Pressure
Vasopressor
Flow
Inotrope
Parameter to target
CVP 10-15
PAC
targets
DO2
Low Sao2
See CXR
Low SV, DO2
High HR,
Resistances
DO2
Avoid
BP potency: Dopamine...NEVasopressin/Phenylephrine