2. DEFINITION
• Profound hemodyamic and metabolic
disturbance characterized by failure of the
circulatory system to maintain adequate
perfusion of vital organs
9. Presentation of Hypovolemic
Shock
• Hypotensive
• flat neck veins
• clear lungs
• cool, cyanotic extremities
• evidence of bleeding?
– Anticoagulant use
– trauma, bruising
• oliguria
10. Distributive Shock
• Peripheral Vasodilation secondary to disruption
of cellular metabolism by the effects of
inflammatory mediators.
• Gram negative or other overwhelming infection.
• Results in decreased Peripheral Vascular
Resistance.
13. Swan-Ganz Catheter
• Utilized to differentiate types of shock and
assist in treatment response.
• Probably overused by physicians. Studies
documenting increased mortality in patients
with catheters versus no catheters, although
somewhat swayed by selection bias.
17. Management
• Correct underlying disorder if possible and
then direct efforts at increasing the blood
pressure to increase oxygen delivery to the
tissues.
• Maintain a mean arterial pressure of 60
(1/3 systolic + 2/3 diastolic)
• Keep O2 sats >92%, intubate if neccesary
18. Correction of hypotension
• Normal Saline should be administered
anytime a patient is hypotensive. If
hypotension exists give more NS. ***
• If possible give blood as it replaces colloid.
• Vasopressors
• Inotropic agents for cardiogenic shock
• Intra-aortic Balloon Pump for cardiogenic
20. Management of Cardiogenic
Shock
• Attempt to correct problem and increase
cardiac output by diuresing and providing
inotropic support. IABP is utilized if
medical therapy is ineffective.
Catheterization if ongoing ischemia
• Cardiogenic shock is the exception to the
rule that NS is always given for
hypotension NS will exacerbate cardiac
shock.
22. Management of Septic Shock
• Early goal directed therapy
• Identification of source of infection
• Broad Spectrum Antibiotics
• IV fluids
• Vasopressors
• Steroids ??
• Recombinant human activated protein C ( Xygris)
• Bicarbonate if pH < 7.1
23. Management of Hypovolemic
Shock
• Correct bleeding abnormality
• If PT or PTT elevated then FFP
• Aggressive Fluid replacement with 2 large
bore IV’s or central line.
• Pressors are last line, but commonly
required.
24. Addison’s Disease
• Deficiency of cortisol and aldosterone
production in the adrenal glands
• This is suspected when patient is non-
responsive to fluids and antibiotics.
• Electrolytes may reveal hyponatremia and
hyperkalemia
• Hydrocortisone 100 mg IV immediately
then taper appropriately