Question

1. Indicate treatment for each type of shock (Medications, IV fluid, blood products, procedures). Be specific. Indicate which hemodynamic value the treatment will help correct. All of the values affected need addressed, accept for SvO2 & ScvO2. Make sure to include the name of medications (vasopressors like Norepinephrine). For instance, Normal Saline or Lactated Ringers are given to increase intravascular volume which increases CVP.

Classification of Shock	Hemodynamic Values	Treatment
Anaphylactic Shock	HR: >100 beats/min BP: < 130/80 mm Hg CO: < 4 L/min CI: < 2.5 L/min/m2 RAP: < 2 mm Hg PAOP: < 8 mm Hg PADP: < 8 mm Hg SVR: < 770 dynes/sec/cm-5 SvO2: < 60%
Cardiogenic Shock	HR: >100 beats/min BP: < 130/80 mm Hg CO: < 4 L/min CI: < 2.5 L/min/m2 RAP: > 6 mm Hg PAOP: >12 mm Hg PADP: > 15 mm Hg SVR: > 1500 dynes/sec/cm-5 SvO2: < 60%
Hypovolemic Shock	HR: >100 beats/min BP: < 130/80 mm Hg CO: < 4 L/min CI: < 2.5 L/min/m2 RAP: <2 mm Hg PAOP: < 8 mm Hg PADP: < 8 mm Hg SVR: > 1500 dynes/sec/cm-5 SvO2: < 60%
Neurogenic Shock	HR: < 60 beats/ min (normal to low) BP: < 130/80 mm Hg (normal to low) CO: < 4-8 L/min (normal to low) CI: < 2.5-4.0 L/min/m2 (normal to low) RAP: < 2 mm Hg PAOP: < 8 mm Hg PADP: < 8 mm Hg SVR: < 770 dynes/sec/cm-5 SvO2: < 60%
Obstructive Shock	HR: >100 beats/min BP: < 130/80 mm Hg CO: < 4 L/min CI: < 2.5 L/min/m2 RAP: > 6 mm Hg PAOP: >12 mm Hg (High if impaired diastolic filling or high LV afterload) PADP: < 8 mm Hg (Low if high RV afterload) SVR: < 770 dynes/sec/cm-5 SvO2: < 60%
Septic Shock	HR: >100 beats/min BP: < 130/80 mm Hg (normal to low) CO: (high then low) >8 then < 4 mm Hg CI: (high then low) >4 then < 2.5 mmHg RAP: low to variable PAOP: (low to variable) PADP: (low to variable) SVR: (low to variable) SvO2: <60%

Answer 1

ANAPHYLACTIC SHOCK	Airway protection and oxygen supply Epinephrine (vasoconstrictor) Antihistamines, corticosteroids (anti-inflammatory) Iv fluids (normal saline)
CARDIOGENIC SHOCK	Inotropic agents (norepinephrine/dopamine) Heparin, Aspirin (anticoagulant) Thrombolytics and antiplatelets (clopidogrel) Ringer lactate
HYPOVOLEMIC SHOCK	Stop bleeding Normal saline/ Ringer lactate infusion Blood transfusion Vasopressin
NEUROGENIC SHOCK	Atropine (increases H.R ) Epinephrine/Norepinephrine Dopamine, Vasopressin
SEPTIC SHOCK	Intravenous antibiotics Vasopressors Corticosteroids Ventilator support