Page 242 - Critical Care Notes

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MULTISYS

Diagnostic Tests
Diagnosis and treatment of shock must be tailored to the cause.
■ Serum chemistries, including electrolytes, BUN, and creatinine
■ CBC and coagulation profile
■ ABGs or pulse oximetry
■ Cardiac output studies → ↓ CI, ↓ CO, ↓ preload, ↓ right atrial pressure (RAP),
↑ afterload, and ↑ systemic vascular resistance
■ Cardiac markers may be useful: MB-CPK, troponin, BNP
■ Serum lactate
■ Urinalysis with specific gravity, osmolarity, and urine electrolytes
■ ECG
■ Echocardiogram and cardiac angiography if cardiac origin
■ CXR possibly helpful
Management
■ Monitor vital signs and hemodynamics via arterial line and pulmonary
artery catheter.
■ Institute cardiac monitoring and treatment of dysrhythmias.
■ Assess respiratory status and ABGs or pulse oximetry.
■ Administer O 2 via cannula, mask, or mechanical ventilation. Assess for
signs of hypoxia.
■ Note skin color and temperature. Control fever.
■ Assess neurological status and LOC.
■ Administer IV fluids such as 0.9% NS and LR. Consider colloids and other
crystalloids cautiously to prevent heart failure.
■ Consider albumin and blood transfusions.
■ Insert Foley catheter. Monitor intake and output.
■ Assess fluid and electrolyte balance.
■ Administer IV vasopressors as indicated by hemodynamic parameters.
■ Administer IV vasodilators and diuretics to ↓ preload or afterload.
■ Administer sympathomimetics and digoxin to ↑ contractility.
■ Administer antiarrhythmics if cardiac dysrhythmias are present. Consider
cardioversion or a pacemaker if appropriate.
■ Provide nutritional support, either enterally or parenterally.
■ Institute intra-aortic balloon pump counterpulsation for cardiogenic shock
or ventricular assist device. Consider percutaneous coronary intervention
(PCI) or coronary artery bypass graft (CABG) to decrease myocardial work-
load and improve end-organ perfusion.
■ Monitor serum lactic acid level. Administer sodium bicarbonate (not recom-
mended in the treatment of shock-related lactic acidosis).
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