Shock Essentials in 8 Minutes

Shock:  Inadequate perfusion at the cellular level.

“The rude unhinging of the machinery of life” ~ Samuel D. Gross

Adequate Perfusion requires:

1. The Pump (heart)
2. The Fluid (blood)
3. The Container (vasculature)
4. Air Exchange (oxygenation / ventilation)

The Pump

• Adequate Cardiac Output
• Stroke Volume X Heart Rate (4-8L/minute)
• Affected by Preload, Contractile Force, and Afterload

The Fluid

• Volume of blood must fill container

The Container

• Vasculature is properly sized
• Pre and post capillary sphincters at local level

Air Exchange

• O2 into lungs and circulation
• Elimination of CO2 and waste products

• REQUIRES:
• Adequate FiO2 and ventilation
• Diffusion across alveoli / capillary membrane
• Adequate number of RBCs
• Efficient offloading to target cells

Stages of Shock

• Compensated
• Decompensated
• Irreversible

Types of Shock

• Hypovolemic
• Cardiogenic
• Distributive
• Obstructive

Managing Shock

• Primary Survey / ABCs
• O2
• BVM
• C  spine
• Major bleeding
• Supine / Keep warm
• IV, monitor

Specific Treatments

• Fluid challenge
• Epi / Benadryl (anaphylaxis)
• Chest decompression (tension pneumothorax)
• Pericardiocentesis (cardiac tamponade)
• Dysrhythmias (ACLS)
• Pressors (fluids first)
• Narcan (opiod OD)

Take Home Points

1. Shock:  Inadequate perfusion at the cellular level.
2. If you think shock, your patient is already there.
3. Know and treat the root causes.
4. Set a target MAP.
5. Be aggressive!

Chip Getchell

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