Recognizing and managing a patient in shock – USMLE Step 2 CK exam

by / Friday, 11 June 2010 / Published in Internal Medicine, Surgery

 

The type of shock can be diagnosed by checking the cardiac output (CO), the pulmonary capillary wedge pressure (PCWP), and the peripheral vascular resistance (PVR).

Differential Diagnosis of Shock

  HYPOVOLEMIC CARDIOGENIC SEPTIC
CO  decreased  decreased  increased
PCWP  decreased   increased  decreased
PVR  increased  increased  decreased

 

How to correct the different types of shock

  Problem Initial Treatment
Hypovolemic Shock Decreased Preload 2 Large bore IV’s, replace fluids
Cardiogenic Shock Cardiac Failure 02, dopamine and/or NE
Septic Shock Decreased PVR 02, NE, IV antibiotics

 

 

Recognizing Shock

In Chest trauma:

  • The most common type of shock resulting from chest trauma is hypovolemic
  • Patient will be pale, cold, and diaphoretic 
  • This patient is likely losing large amounts of blood, thus searching for soure of bleeding is imperative 
  • Pericardial tamponade can be a result of thoracic trauma, look for distended neck veins 
  • In suspected pericardial tamponade, look for an enlarged heart on CXR, perform cardiocentesis, look for electrical alternans on EKG 

Management of shock:

  • Control the site of bleeding 
  • Give fluids
  • Prepare for an emergency laparotomy

** if a laparotomy isn’t warranted, simply resuscitate with fluids

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To your success in weight loss and in health,

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