Clinical meaning
Shock is a state where DO2 fails to meet VO2, leading to cellular hypoxia and lactate production.
Cardiogenic: Low CO, High SVR, High PCWP. Septic: High CO (early), Low SVR, Low/Normal PCWP. Hypovolemic: Low CO, High SVR, Low PCWP.
Diagnosis & workup
Diagnostics & workup: - Order serial lactate levels every 2-4 hours to assess tissue perfusion - Order central venous catheter for CVP and ScvO2 monitoring - Order arterial line for continuous MAP monitoring - Order echocardiogram to assess cardiac output and filling pressures - Order CBC, BMP, coagulation panel, blood type and crossmatch - Order cortisol level (random) for adrenal insufficiency assessment - Order PA catheter placement for refractory shock (CO, SVR, PCWP) - Order point-of-care ultrasound (POCUS) for rapid assessment
Risk factors: - Major trauma - Massive hemorrhage - Acute MI with large territory - Sepsis with delayed treatment - Severe anaphylaxis - High spinal cord injury (above T6) - Massive pulmonary embolism - Cardiac tamponade