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Shock... Now What?
- 1. MY PATIENT IS IN SHOCK… NOW WHAT? Chris Nickson FACEM FCICM Intensivist, The Alfred ICU
- 3. OVERVIEW Resuscitation Seek & treat the cause! Fluid therapy Vasoactive agents! Hemodynamic targets Refractory Shock!
- 5. Shock is a state of ! circulatory failure – ! tissue perfusion is inadequate ! to meet the needs of the body!
- 7. Shock is not a diagnosis – ! seek and treat the ! underlying cause!
- 8. Requires a coordinated ! team-based approach ! with simultaneous ! assessment and management!
- 9. SEEK & TREAT THE CAUSE (NOW WHAT?)
- 11. SHOCKCAUSES Pump Rate / rhythm Obstructive Volume Endocrine Distributive ? (is there an error?)
- 14. Courtesy of @emresus (Sam Ghali)!
- 15. SHOCKCAUSES Pump Rate / rhythm Obstructive Volume Endocrine Distributive ? (is there an error?)
- 18. “You can resuscitate a patient with sterile dog piss if you want – just give the right amount of it!”! Sir Malcolm Fisher!
- 19. Use crystalloids and ! do not give “too much”!
- 20. Bolus and reassess…! usually up to about ! mL/kg20mL/kg!
- 21. Levitov and Marik (2012) PMC3171766!
- 22. Fluid responsiveness does not mean you should give fluid!
- 23. Give blood ! if bleeding or significantly anaemic
- 25. Start early using ! peripheral IV access!
- 26. Norepinephrine is first line vasoactive agent for undifferentiated shock! (usually)!
- 28. MAP (mmHg) 65
- 29. Individualise targets according to ! the patient, the context! and the phase of illness!
- 30. Frequent assessment ! of the whole patient is ! more important than an! invasive monitor
- 31. Other targets are ! important too!! ! SaO2 PaCO2 pH glucose! Lactate ScvO2!
- 33. Reassess frequently ! and consider the ! underlying cause(s) ! (PROVED?)!
- 34. Use Occam’s Razor but remember! Hickam’s Dictum!!!!
- 35. “Let no one die without a ! trial of steroids”! ! Hydrocortisone 50mg q6h!
- 36. Add vasoactive agents ! and consider ! circulatory assist devices
- 37. SUMMARY Resuscitation Seek & treat the cause! Fluid therapy Vasoactive agents! Hemodynamic targets Refractory shock!