Shock
Description General measures Medicine treatment Fluid therapy for shock Vasoactive medicines for shock ICD-10 code: R57 Description Shock is defined as a state where perfusion is inadequate to meet the metabolic needs at a cellular level. There are various forms of shock each requiring their own specific treatment. LoE: IVb iii General Measures The therapeutic aim for all types of shock is to res
Vasoactive medicines for shock
ICD-10 code: R57
Description
Shock is defined as a state where perfusion is inadequate to meet the metabolic needs at a cellular level. There are various forms of shock each requiring their own specific treatment.
General Measures
The therapeutic aim for all types of shock is to restore perfusion and maintain an adequate blood pressure, e.g. Mean Arterial Pressure (MAP) >65mmHg.
Management includes fluid therapy and administration of vasoactive medication that may vary depending on the type of shock (See Shock):
For hypovolaemic shock: see Hypovolaemic shock.
For distributive shock: see Distributive shock.
For anaphylactic shock: see Anaphylaxis/ anaphylactic shock.
For neurogenic shock: see Neurogenic shock.
For septic shock: see Septic shock and Sepsis in ICU.
For cardiogenic shock: see Cardiogenic shock.
For obstructive shock: see Obstructive shock.
Medicine Treatment
Fluid therapy
Balanced salt solutions are the preferred resuscitation fluids for shock. Adequacy of fluid resuscitation should be guided by measures of fluid responsiveness.
CAUTION
Avoid colloids for shock resuscitation in patients with sepsis and acute kidney injury.
Vasoactive therapy
Vasoactive therapy is indicated in a shocked patient that fails to respond to fluid therapy.
- Adrenaline, IV, 0.01-1.0 mcg/kg/min as a continuous infusion.
- Aim to achieve a target MAP >65mmHg within 30 minutes.
If shock is suspected to be cardiogenic in origin:
- Dobutamine, IV, 5-20 mcg/kg/min as a continuous infusion.
Fluid Therapy for shock
Description
- Balanced salt solutions are the preferred resuscitation fluids for shock.
- Adequacy of fluid resuscitation should be guided by measures of fluid responsiveness.
CAUTION
Avoid colloids for shock resuscitation in patients with sepsis and acute kidney injury.
Vasoactive medicines for shock
Description
Vasoactive therapy is indicated in a shocked patient that fails to respond to fluid therapy.
Medicine Treatment
- Adrenaline, IV, 0.01-1.0 mcg/kg/min as a continuous infusion.
- Aim to achieve a target MAP >65mmHg within 30 minutes.
If shock is suspected to be cardiogenic in origin:
- Dobutamine, IV, 5-20 mcg/kg/min as a continuous infusion.
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Standard Treatment Guidelines and Essential Medicines List for South Africa Adult Hospital _Chapter 23: Adult Critical Care_NEMLC Medicine Recommendations Review Cycle_ 2020_2023