SHOCK

► How would you manage the low urinary output following surgery?

This patient is hypotensive. I would aim to correct this.

I would further volume load this patient to a CVP of 15 -16 cmH2O. If she doesn't increase both her blood pressure and urine output, I would start epinephrine or dopamine  to increase MAP to 100 mmHg. There is no indication for dialysis at this time. "Renal dose dopamine" is scientifically unproven, its main effect is to act as a diuretic. The main objective at this stage is to ensure that the patient has an adequate circulating volume and blood pressure. This patient requires a physiologic renal perfusion pressure, not a diuretic.

Dx: hypovolemic shock due to blood loss, then fluid redistribution.

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