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)