Emergency Medicine-Shock

Question 1

Trauma, blood loss, inadequate fluid repletion, third spacing, burns.

CO↓ PCWP↓ PVR↑

Answer 1

Hypovolemic Shock
Tx: Replete with isotonic solution (e.g. LR or NS) and blood in a 3:1 (fluid to blood ) ratio.

Question 2

Tension pneumothorax, CHF, cardiac tamponade, arrhythmia, structural heart disease (severe mitral regurgitation, VSD) MI (> 40% of LV function).
CO↓ PCWP↑ PVR↑

Answer 2

Cardiogenic Shock
Tx: Identify the cause and treat
Give pressors ie dopamine and/or dobutamine or NE.

Question 3

Bacteremia, especially gram (-) organisms.
CO↑ PCWP↓ PVR↓

Answer 3

Septic Shock
Tx: Administer fluid and antibiotics.
Consider a Swan- Ganz catheter.
Give Dopamine or NE
Obtain B/C prior to admin of antibiotics

Question 4

Bee stings, medications, food allergies.
CO↑ PCWP↓ PVR↓

Answer 4

Anaphylactic Shock
Tx: Give diphenhydramine. If severe, administer 1:1000 Epinephrine
(Epi-pen)