SHOCK

1.  Definition
- Inadequate perfusion to meet tissue demand.

2. Type 

➢ Compesated

- Tacycardic + cold extrimities (Cold Shock) ~ vasoconstriction

- Bounding pulse + warm periphery (warm shock) - (eg sepsis ~ vessel dilatation)

- Oliguria
- Mild Lactate acidosis

➢ Hypotensive Shock (Uncompesated shock)

- severe lactate acidosis

- prolong CRT

➢ Hypovolumic

➢ Distributive shock

➢ Cardiogenic shock

➢ Obstructive

Sign shock, is it just tacycardic? it is not a specific sign for shock, patient with fever also can have tachycardia. So, need to look : Skin changes - prolong CRT - Impaired mental status (to monitor progression)

4. APPROACH

• ABCD

• Establish life threatening condition/ IV branulla

• Give 20ml/kg as fast as possible

• Ringer Lactate

• Normal saline

• Other isotonic fluid

• Unless suspect cardiogenic shock

5. Ephinephrine in anaphylactic shock

6. Check electrolyte - 

eg Calcium, if patient hypocalcemic, pt can resistant to recuscitation - if low, correct first

7. Consider inotropic drug - Adrenaline or Noradrenaline

8. Cardiogenic shock - dobutamine (if dehydrated, still can give fluid, but beware, may need CVP monitoring)

9. Septic shock – Antibiotic

10. What is different between colloid and crystalloid?

- Albumin which one? 

- Osmolarity?

- Plasma?

11. Fluid resistant resuscitation

- BP still not stable even after given 60ml/kg crystalloid,