Diagnosis and Management of Shock - General principles of shock management
16 important questions on Diagnosis and Management of Shock - General principles of shock management
What are the first and second goals of shock therapy?
2) improve oxygen delivery
Four components of shock therapy?
- Treatment of etiology
- Restoration of perfusion
- Monitoring
- Supportive Care
In the initial resuscitation fluid is given untill...
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What is the effect of dopamine on urine output, HR & BP?
UO: increased in low doses (1-5)
HR: increased in intermediate doses (6-10)
BP: increased in higher doses (>10)
For even higher dosis nor is better, dopamine might cause arrhythmias.
What is the dose range and eenheid of dopamine?
What is the effect of nor on HR & BP?
HR: +
BP: ++++ (alfa!)
With increasing AL en BP, CO might decreases
Improves renal blood flow
Increase in HR is uncommon
What is the effect of epi on HR & BP?
HR: ++++
BP: +++ (beta2) > vasoconstrictor at higher doses
Side effects of epi? (2)
Increase myocardial oxygen consumption
Aerobic lactate producation (instead of hypoperfusion-induced)
What is the effect of fenylepifrine on HR & BP?
HR: /
BP +++ (alfa)
pure alfa > arterial dilation without cardiac depression > e.g. Neurogenic shock or hypotension by epidural anesthetic
What is the dose range and eenheid of fenylepifrine?
What is the effect of vasopressin on HR & BP?
HR: /
BP: potent (V1 receptor)
Indication: refractory hypotensive shock
What is the effect of dobutamine on HR & BP?
HR: +++ / ++++++ (a.k.a. Tachycardia in hypovolemic)
BP: ++ (beta2) / --- in hypovolemic
Inotrope > increase CO/stroke volume
What is the effect of milrinone on HR & BP?
HR: +++
BP: +++ (beta 2) / beta2 = dilatation > don't kill hypovolemic patients
> CO > stroke volume
Priorities in septic shock (5-6)
- volume (sec. vasopressor (nor > epi)
- AB
- control infection (catheter removal, surgery, drainage etc)
- lactate
- cortico's (200 mg/24u)
in case of myocardial dysfunction: dobutamine
Priorities in anaphylactic shock (2-3)
- volume
- subcutaneous epi
very low BP: IV epi
Priorities in adrenal insufficiency (3)
- volume
- IV cortico
- vasoactive med if needed
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