Circulation Flashcards
Circulation
Hypovolemic
Shock
Hemorrhage
GI losses
Third spacing
Dehydration
Over diuresis
Circulation
Obstructive
Shock
(Intra-Thoracic)
Pulmonary embolism
Cardiac tamponade
Tension pneumo
Valvular dysfunction
Congenital heart disease
Air embolism
Circulation
Distributive
Shock
(Vasodilation)
Septic shock
Anaphylactic shock
Neurogenic shock
Drug overdose
Adrenal crisis
Circulation
Cardiogenic
Shock
ACS
Cardiomyopathy
Cardiac structural
damage
Dysrhythmias
Circulation
Assessment
Clinical symptoms and signs suggestive of shock
Vitals: ↑HR,↓ BP, ↑RR High initial lactate
Urine Output <0.5mL/kg/hr Skin mottling
Capillary refill time >3 secs Altered mental status
Circulation
Investigations Labs
CBC
CMP
BUN/Cr
TnI
VBG/ABG
Lactate
BCx2
Respiratory Culture
UA/UC
Procal
Circulation
Investigations Tests
CXR
ECG
POCUS – RUSH exam (cardiac, IVC, lungs, aorta)
Circulation
Management
Perfusion Goals
Perfusion Goals
Urine Output >0.5mL/kg/h
MAP >65mmHg
Improved mentation,
Improved cap refill time
Lactate clearance
Circulation
Management
Hemorrhagic Hypovolemic Shock: fill the tank
Control hemorrhage (tourniquets, direct compression, pelvic binders)
Fluids until blood available, balanced transfusion (1:1:1 of
pRBCs:platelets:FFP)
Circulation
Management
Obstructive Shock: alleviate obstruction
Tension pneumothorax: needle decompression then chest tube
Cardiac tamponade: IV crystalloids, pericardiocentesis
PE: IV crystalloid, inotropes, thrombolysis
Circulation
Management
Distributive Shock: source control, squeeze the pipes
Anaphylaxis: Epinephrine IM, IV fluids, antihistamines if symptomatic,
corticosteroids
Sepsis: Broad-spectrum antibiotics, IV fluids +/- norepinephrine
Circulation
Management
Cardiogenic Shock: support forward flow
Norepinephrine 0-20μg/min, dobutamine 0-5μg/kg/min
Treat underlying cause: cath lab, mechanical circulatory support (IABP,
Impella, VAD, ECMO), heart transplant
Cellular Toxins
Antidote
