Shock

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ATLS Classes of Shock

Causes

• preload collapse
  • absolute hypovolaemia
  • relative hypovolaemia (venous expansion)
  • haemorrhage
  • burns
  • severe vomiting / diarrhoea
  • excessive urinary loss
    • Diabetic Ketoacidosis
    • diuretic phase of acute tubular necrosis
    • powerful diuretics
  • sequestration of fluid in bowel
  • loss of fluid into interstitium
    • sepsis syndrome
    • acute pancreatitis
    • generalised peritonitis
• Pump failure
  • acute Myocardial Infarction
  • acute ventricular arrythmias
  • cardiac valve prolapse
  • large pulmonary embolus
• Afterload collapse
  • septic shock (Gram-negative infections)
  • Anaphylaxis

Clinical Features

• fall in arterial blood pressure
• heart rate increases
• cutaneous vasoconstriction
• profuse sweating
• metabolic acidosis

Management

• oxygen
• venous access
• restore perfusion with Fluid
  • colloids
    • Gelofuscine
    • Haemaccel
• assessment
  • basic obs
  • history / context
  • general examination
  • ECG
  • CVP
  • urinary catheter
  • bloods
    • Hb
    • haematocrit
    • U&Es
    • X-match
    • ABGs
    • blood cultures
    • blood glucose

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