Shock

Shock

• Definitions
• Septic Shock
• Cardiogenic Shock
• Hypovolemic

Helpful Guidelines

• Surviving Sepsis
  • Management of Sepsis
• Management of Cardiogenic Shock
• Hypovolemic / Hemorrhagic Shock

https://bestpractice.bmj.com/topics/en-gb/779

Sepsis

Septic Shock

"Patients with septic shock can be clinically identified by a vasopressor requirement to maintain a mean arterial pressure of 65 mm Hg or greater and serum lactate level greater than 2 mmol/L (>18 mg/dL) in the absence of hypovolemia."

CMAJ September 10, 2018 190 (36) E1058-E1059; DOI: https://doi-org.proxy1.lib.uwo.ca/10.1503/cmaj.170149

SIRS

*in 2-4 h

Really... use your judgement 

(don't give 3 L of IVF to your HF patient

qSOFA

Cardiogenic Shock

Sit the patient up!

High flow O2

DIURESE!

Lasix no max dose (typically 40-120 mg IV )

Nitro patch or spray

Call for help if not improving

Left Bundle Branch Block

• LBBB
  • QRS duration >0.12 seconds
  • Broad monomorphic R waves in I, aVL, V5, and V6 (Depolarization moving toward these leads)
  • Broad, dominant, monomorphic S wave in V1 and V2 (Depolarization moving away from these leads)

Hypovolemic Shock