Shock: Inadequate perfusion at the cellular level.
“The rude unhinging of the machinery of life” ~
Adequate Perfusion requires:
- The Pump (heart)
- The Fluid (blood)
- The Container (vasculature)
- Air Exchange (oxygenation / ventilation)
- Adequate Cardiac Output
- Stroke Volume X Heart Rate (4-8L/minute)
- Affected by Preload, Contractile Force, and Afterload
- Volume of blood must fill container
- Vasculature is properly sized
- Pre and post capillary sphincters at local level
- O2 into lungs and circulation
- Elimination of CO2 and waste products
- Adequate FiO2 and ventilation
- Diffusion across alveoli / capillary membrane
- Adequate number of RBCs
- Efficient offloading to target cells
Stages of Shock
Types of Shock
- Primary Survey / ABCs
- C spine
- Major bleeding
- Supine / Keep warm
- IV, monitor
- Fluid challenge
- Epi / Benadryl (anaphylaxis)
- Chest decompression (tension pneumothorax)
- Pericardiocentesis (cardiac tamponade)
- Dysrhythmias (ACLS)
- Pressors (fluids first)
- Narcan (opiod OD)
Take Home Points
- Shock: Inadequate perfusion at the cellular level.
- If you think shock, your patient is already there.
- Know and treat the root causes.
- Set a target MAP.
- Be aggressive!