Aidan: /* Classes of shock */

2020-07-29T15:07:01Z

Classes of shock

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2020-07-04T01:17:55Z

Imported from text file

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== Definition ==

* Inadequate tissue perfusion and oxygenation leading to multiorgan dysfunction

== Shock Index ==

* Heart Rate / Systolic Blood Pressure
* Usual range 0.5 to 0.7
* If over 0.9, suggests impaired cardiac function and predicts mortality

== Approach ==

<pre class="mermaid">graph TB

Start["BP = CO x SVR"] --> LowCO["Low cardiac output (CO)"]
Start --> LowSVR["Low systemic vascular resistance (SVR)"]

LowCO --> CNC["Cold and clammy"]
CNC --> HighJVP["High JVP"]
CNC --> LowJVP["Low JVP"]

HighJVP --> Cardio["Cardiogenic shock"]
HighJVP --> Obstruct["Obstructive shock"]
LowJVP --> Hypo["Hypovolemic shock"]

LowSVR --> WNB["Warm and bounding pulse"]
WNB --> Distro["Distributive shock"]
</pre>
== Differential Diagnosis ==

* [[Cardiogenic shock]]
* Obstructive shock
** Massive pulmonary embolism
** Tension pneumothorax
** Cardiac tamponade
** Right ventricular infarction
* Hypovolemic shock
* Distributive shock
** [[Sepsis]]
** [[Anaphylaxis]]
** [[Systemic inflammatory response]]
** Mitochondrial dysfunction
*** Cyanide poisoning
** Adrenal crisis
** Myxedema coma
** Neurogenic

== Clinical Presentation ==

* Hypoperfusion
** Low BP (SBP < 90, MAP < 65, decrease in SBP by 40+)
** BP unresponsive to fluid challenge
** Long cap refill
* End-organ dysfunction
** Lightheadedness
** Confusion
** Diaphoresis
** Decreased urine output
** Increased creatinine
** Chest pain
** Other ischemic pain

=== Classes of shock ===

{|
!
! Class I
! Class II
! Class III
! Class IV
|-
| Blood loss (mL)
| <750
| 750-1500
| 1500-200
| >2000
|-
| Blood loss (%)
| <15%
| 15-30%
| 30-40%
| >40%
|-
| HR
| <100
| >100
| >120
| >140
|-
| BP
| Normal
| Normal
| Low
| Low
|-
| Pulse pressure
| Normal
| Low
| Low
| Low
|-
| RR
| 14-20
| 20-30
| 30-40
| >40
|-
| Urine output mL/h
| >30
| 20-30
| 5-15
| anuria
|-
| Mental status
| anxious
| anxious
| confused
| lethargic
|}

[[Category:Critical care]]

Shock - Revision history

Aidan: /* Classes of shock */

Maintenance script: Imported from text file