1.10 Approach to Pt w/ Hypotension
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What is hypotension?
<90 mmHg (systolic)
What is shock?
"When the amt of useful energy transferred into the roots of the pulmonary artery and the aorta is insufficient to meet the body's basal metabolic needs"
What is the mechanism behind the main categories of shock?
- Decreased tissue perfusion
- Decreased O2 delivery
- Cell death
- End organ failure (renal failure/ cardiac/ liver failure)
- Multi-system organ failure (late stages)
What is the hemodynamics behind the main categories of shock?
- Hypovolemic: ↓ Preload = ↓ CO = ↑ SVR
- Cardiogenic: ↓CO = ↑ Preload = ↑ SVR
- Obstructive: ↓ CO = ↑ Preload = ↑ SVR
- Distributive: ↓ SVR = ↑CO = ↓ Preload
What are the cardinal symptoms of shock?
- Mental Status Change
- Metabolic Acidosis
What are the suggestive findings of a Hypovolemic Shock?
- Decreased skin turgor (swelling), dry skin, dry tongue, dry oral mucosa
- Postural hypotension, decreased JVP
What is the initial approach in the tx of shock?
- Early, adequate hemodynamic support is crucial
- Ventilatory support (O2 administration), usually intubation
- Infuse- Fluid Resuscitation
What are the suggestive findings of a Cardiogenic Shock?
- Lung exam has diffuse crackles
- Cardiac exam has few murmurs, gallops, or heart sounds
- Increased JVP and central venous pressure
What are the suggestive findings of a Obstructive Shock?
- Decreased breath sounds (pneumothorax)
- Pulsus paradoxus (cardiac tamponade)
What are the suggestive findings of a Distributive Shock?
Fever, tachypnea, tachycardia, leukocytosis, flushing
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