Circulation (Shock)

Tank. Clogged Pipes. Broken Pipes. Pump.











Introduction











* “Tank”* Hypovolemic shock* Hemorrhagic shock* “Clogged Pipes”* Cardiac tamponade* Tension pneumothorax* Pulmonary embolism* “Broken Pipes”* Septic Shock* Neurogenic Shock* Anaphylactic Shock* “Pump”* Cardiogenic Shock











Step 1: Fill the Tank











* Establish an IV* IO line alternative in emergent situations











Step 2: Consider Clogs











* Cardiac tamponade* Diagnosis: Ultrasound* Treatment: Pericardiocentesis* Tension pneumothorax* Diagnosis: Clinical/Xray/Ultrasound* Treatment: Needle decompression and tube thoracostomy* Pulmonary embolism* Diagnosis: Clinical/CTA* Treatment: Thrombolytics











Step 3: Squeeze the Pipes











* Administer vasopressors* Most common: Norepinephrine* Alternatives: Epinephrine, Phenylepherine











Step 4: Analyze the Pump











* Get an EKG* Ischemia = Aspirin/Heparin/Cath lab* Dysrhythmia = Electricity











Additional Reading











* Airway Part 1 – Immediate Actions (EM Clerkship)* Breathing (EM Clerkship)* RUSH Exam (EMCrit)