Shocks in Adults

Types:
1. Hypovolemic - decreased preload due to volume loss
2. Cardiogenic - cardiac pump failure
3. Distributive (vasodilatory) - severely decreased SVR
4. Combined - ex. septic shock

Types	Preload	Pump Function	Afterload	Tissue Perfusion
Measurement	PCWP	CO	SVR	SvO2
Hypovolemic	↓	↓	↑	↓
Cardiogenic	↑	↓	↑	↓
Distributive	↓/↔	↑	↓	↑

Stages of Shock:

1. Preshock

2. Shock

3. End-organ dysfunction

Septic Shock

Mortality: 20~50%

Goals:
1. Early initiation of supportive care to correct physiologic abnormalities, ex. hypotension/hypoxemia.
2. Distinguishing sepsis from SIRS to treat infections ASAP

Management
1. Stabilize respiration
   A. Supplemental Oxygen + monitor w/ pulse oximetry
       a. Intubation/mechanical ventilation
       b. CXR + ABG

2. Assess Perfusion
   A. Inadequate perfusion
       a. Hypotension: SBP <90 mmHg, MAP <70 mmHg,  ↓ SBP >40 mmHg
           a)  Causes: loss of plasma volume into the interstitial space, decreased vascular tone, and myocardial depression.
       b. S/S:  cool, vasoconstricted skin, HR>90/min, obtundation/restlessness, and oliguria/anuria, serum lactate >1 mmol/L
       c. If BP labile --> A-line