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Shock... Now What?
- 1. MY PATIENT ISIN SHOCK… NOW WHAT? Chris Nickson FACEM FCICM Intensivist, The Alfred ICU
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- 3. OVERVIEW Resuscitation Seek & treatthe cause! Fluid therapy Vasoactive agents! Hemodynamic targets Refractory Shock!
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- 5. Shock is astate of ! circulatory failure – ! tissue perfusion is inadequate ! to meet the needs of the body!
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- 7. Shock is nota diagnosis – ! seek and treat the ! underlying cause!
- 8. Requires a coordinated! team-based approach ! with simultaneous ! assessment and management!
- 9. SEEK & TREATTHE CAUSE (NOW WHAT?)
- 11. SHOCKCAUSES Pump Rate / rhythm Obstructive Volume Endocrine Distributive ?(is there an error?)
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- 14. Courtesy of @emresus(Sam Ghali)!
- 15. SHOCKCAUSES Pump Rate / rhythm Obstructive Volume Endocrine Distributive ?(is there an error?)
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- 18. “You can resuscitate a patientwith 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…! usuallyup to about ! mL/kg20mL/kg!
- 21. Levitov and Marik(2012) PMC3171766!
- 22. Fluid responsiveness doesnot mean you should give fluid!
- 23. Give blood ! ifbleeding or significantly anaemic
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- 25. Start early using! peripheral IV access!
- 26. Norepinephrine is firstline vasoactive agent for undifferentiated shock! (usually)!
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- 29. Individualise targets according to! the patient, the context! and the phase of illness!
- 30. Frequent assessment ! ofthe whole patient is ! more important than an! invasive monitor
- 31. Other targets are! important too!! ! SaO2 PaCO2 pH glucose! Lactate ScvO2!
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- 33. Reassess frequently ! andconsider the ! underlying cause(s) ! (PROVED?)!
- 34. Use Occam’s Razor but remember! Hickam’s Dictum!!!!
- 35. “Let no onedie without a ! trial of steroids”! ! Hydrocortisone 50mg q6h!
- 36. Add vasoactive agents! and consider ! circulatory assist devices
- 37. SUMMARY Resuscitation Seek & treatthe cause! Fluid therapy Vasoactive agents! Hemodynamic targets Refractory shock!
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