Check/manage the following in order:
Pulse (assess based on patient's age)
Too slow or too fast (to the point where CO is affected)?
If so, HR is likely primary etiology of hypotension
Pace or cardiovert
Volume status
What is the LV end-diastolic volume?
Approximated by the IVC diameter or CVP
If low:
Assess for blood loss versus fluid loss
FAST for intra-abdominal bleed
US for ruptured AAA
Guaiac for GI bleed
CXR for hemothorax
Treat with IVF and/or pRBCs depending on cause
Contractility
Is the myocardium severely depressed in its contractile function (cardiogenic shock)?
Assess via ultrasound
Treat with inotrope (e.g. epinephrine, dopamine
Is forward flow occurring?
Assess for valvular dysfunction (MR, AR)
Assess for obstruction (PE, tamponade)
Systemic Vascular Resistance
Pathologic vasodilation (decreased SVR) suggested by:
Warm extremities
Bounding pulse
Treated based on likely etiology of distributive shock (see below)
Too slow or too fast (to the point where CO is affected)?
If so, HR is likely primary etiology of hypotension
Pace or cardiovert
If so, HR is likely primary etiology of hypotension
Pace or cardiovert
What is the LV end-diastolic volume?
Approximated by the IVC diameter or CVP
If low:
Assess for blood loss versus fluid loss
FAST for intra-abdominal bleed
US for ruptured AAA
Guaiac for GI bleed
CXR for hemothorax
Treat with IVF and/or pRBCs depending on cause
Approximated by the IVC diameter or CVP
If low:
Assess for blood loss versus fluid loss
FAST for intra-abdominal bleed
US for ruptured AAA
Guaiac for GI bleed
CXR for hemothorax
Treat with IVF and/or pRBCs depending on cause
Assess for blood loss versus fluid loss
FAST for intra-abdominal bleed
US for ruptured AAA
Guaiac for GI bleed
CXR for hemothorax
Treat with IVF and/or pRBCs depending on cause
FAST for intra-abdominal bleed
US for ruptured AAA
Guaiac for GI bleed
CXR for hemothorax
Is the myocardium severely depressed in its contractile function (cardiogenic shock)?
Assess via ultrasound
Treat with inotrope (e.g. epinephrine, dopamine
Is forward flow occurring?
Assess for valvular dysfunction (MR, AR)
Assess for obstruction (PE, tamponade)
Assess via ultrasound
Treat with inotrope (e.g. epinephrine, dopamine
Assess for valvular dysfunction (MR, AR)
Assess for obstruction (PE, tamponade)
Pathologic vasodilation (decreased SVR) suggested by:
Warm extremities
Bounding pulse
Treated based on likely etiology of distributive shock (see below)
Warm extremities
Bounding pulse
Undifferentiated shock
Cardiogenic
Neurogenic shock
Acute valvular Regurgitation/VSD
Spinal shock
CHF
Cardiogenic shock
Dysrhythmia