Shock Management
-
If BP unrecordable call the cardiac arrest team
-
ABC
(inc high flow Oxygen
)
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Raise foot of bed
-
Wide bore IV access both arms
-
Identify and treat underlying cause
-
Infuse crystalloid fast to raise BP (beware not to overload in
cardiogenic shock)
-
Seek expert help early
-
Ix: FBC, U+E (pre-renal failure?), ABG (lactic
acidosis?), glucose, CRP
ECG: ischaemia
Cross-match, clotting
Blood cultures, urine culture, ECG, CXR
Others: lactate, echo abdo CT, USS
-
Consider arterial line, CV line, bladder catheter (urine flow>
30ml/h)
-
If persistently hypotensive consider inotropes
-
Management:
-
Anaphylaxis:
below
-
Cardiogenic:
below
-
Septic: IV cefuroxime
-
Hypovolaemic: Fluid replacement. Saline/colloid, if bleeding use
blood. Titrate against BP, CVP, urine output.
-
Heat exposure: tepid sponging and fanning
Symptoms
BP
sys
<90mmHg. Pallor, tachycardia, ↓Capill refill,
air hunger, oliguria
Causes
-
Pump failure
-
Cardiogenic shock, secondary (eg pulmonary emoblism)
-
Peripheral circulation failure
-
Hypovolaemia, anaphylaxis, sepsis, neurogenic, endocrine failure
(Addisons or hypovolaemia), iatrogenic
Anaphylactic shock
-
Secure airway. 100% oxygen. Intubate if obstruction imminent
-
Remove the cause. Raise the feet.
-
Adrenaline: IM 0.5mg (ie 0.5ml of 1:1000)
.
-
IV access
-
Chorphenamine 10mg IV and hydrocortisone 200mg IV
-
IVI 0.9% saline. Titrate against BP
-
If wheeze treat for asthma
-
If still hypotensive asmit to ITU.
NB: Adrenaline is only given IV if patient severely unwell or has no
pulse. 1ml of 1:10,000 solution per minute. Stop when response noted.
Description
Type I IgE mediated hypersensitivity reaction. Release of histamine
causes: capillary leak, wheeze, cyanosis, oedema, urticaria
Common preciptants
Drugs (eg penicillin, contrast media), latex, stings
Signs
Itching, erythema, urticaria, oedema.
Wheeze, laryngeal obstruction, cyanosis.
Tachycardia, hypotension.
Cardiogenic Shock
-
Oxygen
-
Diamorphine 2.5mg-5mg for pain and anxiety
-
Ix concurrently: ECG, U+E, CK, ABG, CXR, echo. CT thorax (dissection),
VQ scan (PE)
-
Monitor: CVP, BP, ABG, U+E, urine output, consider Swan-Ganz catheter
-
Correct arrhythmias, U+E abnormalities, acid-base disturbances
-
Consider plasma expander or inotropic support (eg dobutamine)
-
Look for and treat reversible cause
Causes
MI, arrhythmia, pulmonary embolus, tension pneumo, cardiac tamponade,
valvular, dissection