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Uptodate Reference Title
Approach to the patient with undifferentiated hypotension or shock: Ongoing resuscitation
Approach to the patient with undifferentiated hypotension or shock: Ongoing resuscitation
The shaded boxes indicate the points in the process at which no further action needs to be taken, a diagnosis has been made, or continued resuscitation is required.
JVD: jugular venous distension; PE: pulmonary embolus; P2: pulmonic second heart sound; ABG: arterial blood gas; CBC: complete blood count; CXR: chest radiograph; ECG: electrocardiography; DIC: disseminated intravascular coagulation; CT: computed tomography; CTPA: computed tomographic pulmonary angiography; PAC: pulmonary artery catheter; RV: right ventricle; LV: left ventricle; IVC: inferior vena cava; Pcwp: pulmonary capillary wedge pressure; CO: cardiac output; SVR: systemic vascular resistance; SvO2: mixed venous oxyhemoglobin saturation. * Timing and availability depends on institutional resources. Point-of-care ultrasonography may also be used in those in whom routine imaging is unsafe. ¶ Myocardial contractility may be depressed in some forms of distributive shock. Δ The presence of B lines on lung ultrasound may suggest pulmonary edema to support cardiogenic shock. ◊ Detection of fluid in the peritoneal cavity and an aortic aneurysm may support hemorrhagic shock from aneurysm rupture. § Absence of lung sliding may support obstructive shock from tension pneumothorax. ¥ These findings are typical of PE, pulmonary hypertension, and tension pneumothorax. In cardiac tamponade, PAC reading are similar to those in cardiogenic shock; however, right atrial, right ventricular end-diastolic, and pulmonary artery wedge pressures are equal.
