Clinical Approach to Shock Introduction

Hypotension is an indication of 1) an abnormality of heart rate (HR), stroke volume (SV) or peripheral resistance (PR), & 2) failure of the others to compensate. Shock is acute circulatory failure leading to inadequate tissue perfusion and end organ injury: it classified as being due to malfunction of 1) the pump (cardiogenic), 2) the tubing (distributive), or 3) the fluid (hypovolemic). In this tutorial we will apply these principles to a logical approach to hypotension and shock, and work our way through a series of case studies.

Learning Objectives

• Use your knowledge of physiology to find the cause of  hypotension / shock

• Learning basic methods of shock resuscitation and monitoring

The patient is hypotensive, where do I start?

The method that we will use is a series of sequential questions, which will tease through the physiologic causes and responses to hypotension.

The Questions to ask:

• Is this genuine hypotension?

• Is the heart rate appropriate for the blood pressure?

• What is the patient’s volume status (cardiac filling)?

• Does the heart contract normally?

• Is the patient abnormally vasodilated?

Please note: these tutorials are for personal study purposes only.  They are not currently peer reviewed, and no responsibility will be taken for mistakes or inaccuracies. Reproduction of information is forbidden. All material is copyrighted by the GasWorks Group.