Evaluation and Management of Shock States

Moranville, Michael P.; Mieure, Katherine D.; Santayana, Elena M.

doi:10.1177/0897190010388150

Cited by 30 publications

(8 citation statements)

References 160 publications

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“…Vital organ hypoperfusion leads to shock, which, if not rapidly managed, is directly related to mortality. 11 Clinical signs, symptoms, and hemodynamic data of shock help to initially assess, monitor, and provide adequate resuscitation for the patient. Physical examination findings of shock and tissue hypoperfusion, vital signs, tissue perfusion measurement, biochemical markers of metabolism, CVP measurement, and ultrasound parameters help to assess volume status.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of volume status in a prehospital setting by ultrasonographic measurement of inferior vena cava and aorta diameters

Ragaisyte

Bardauskienė

Zelbienė

et al. 2018

Turkish Journal of Emergency Medicine

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ObjectivesThe aim of this study was to evaluate the utility of ultrasonographic measurement of the diameter of the inferior vena cava (IVCD) and abdominal aorta (AAD) for assessing volume status.Material and methodsThis was a prospective, observational study. A total of 23 volunteers participated in the study. Each participant was selected randomly. All participants completed the 2016 Kaunas Marathon. Participants filed out a brief survey about their fluid intake (in standardised glasses) in the 24 h before the race and during the race. Participants underwent ultrasound measurements 10–40 min before the start of the race and 3–15 min after finishing the race. To visualize respiratory variation, M-mode was used, with the beam crossing the IVCD 2 cm from the right atrium. The AAD was measured 1 cm above the celiac trunk. IVCD in expiration (IVCDexp)/AAD was calculated by dividing the value of IVCDexp by the value of AAD. The findings were compared with difference in body mass index.ResultsThe mean weight lost after the marathon was 2.93 kg (p < 0.001). Mean IVCD in inspiration (IVCDins) after the run was lower by 0.39 cm (p < 0.001) then before the run. Mean IVCDexp/AAD after the run was 0.24 cm lower than before the run (p = 0.03). Before and after the marathon, there was a statistically significant negative correlation in weight difference, with mean IVCDexp difference (p = 0.047). There was no statistically significant difference in caval index before and after running.ConclusionUltrasonographic assessment of IVCDexp could be useful in the evaluation of volume status.

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Section: Discussionmentioning

confidence: 99%

Evaluation of volume status in a prehospital setting by ultrasonographic measurement of inferior vena cava and aorta diameters

Ragaisyte

Bardauskienė

Zelbienė

et al. 2018

Turkish Journal of Emergency Medicine

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“…2 Inotropes should always be started when patient is well volume resuscitated. 9 It is important to identify and appropriately start inotropes to decease morbidity in resource limited setup like ours.…”

Section: Resultsmentioning

confidence: 94%

Assessment of patients presenting in shock at emergency department in a tertiary care teaching hospital

Bajracharya

Shrestha

et al. 2016

J Patan Acad Health Sci

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Introductions: Clinical profile of patient presenting with shock is important in early recognition and intervention to improve outcome especially in resource limited setup. This study is designed with an objective to evaluate history, clinical findings, laboratory findings and provisional diagnosis of patient presenting with shock.Methods: This was a cross sectional observational study conducted at Patan Hospital emergency department from September to November 2014. All consecutive patients presenting with shock were included. Patient’s demography (age, sex), provisional diagnosis, major findings (blood pressure, lactate, total count, fluid given, stay in emergency), requirement of inotropes and improvement were analyzed.Results: In three months period, 38 patients presented with shock to the emergency. Out of them 21 (55.3 %) were female and 17 (44.7%) were male. Commonest presenting complain was fever and shortness of breath 12 (31.6%), diarrhea 6 (13.4%) and shortness of breath 5 (13.2%). Septic shock was seen in 17 (44.7%), hypovolemic in 10 (26.3%), cardiogenic 7 (18.4%) and unclassified 4 (10.5%). Mean duration of stay in emergency was 100.6 minutes. Mean fluid given in emergency was 2328.9 milliliters.Conclusions: Sepsis was an important cause of shock in the emergency department. Pneumonia was common cause of sepsis and chronic obstructive pulmonary disease was common underlying condition.Journal of Patan Academy of Health Sciences, Vol. 3, No. 1, 2016, Page: 18-22

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“…In fact, norepinephrine has increasingly proven to be of benefit in the management of hypovolemic and cardiogenic shock by either venous α or β 2 -adrenergic stimulation[ 18 19 20 ] and decreases myocardial oxygen consumption in situations of tachycardia and tachyarrhythmias. [ 21 22 ] It is also recommended as the first choice of vasopressors in European guidelines for the management of hemorrhagic and cardiogenic shock. [ 11 12 ] However, these guidelines have not been widely accepted to the same degree as those for septic shock.…”

Section: Discussionmentioning

confidence: 99%

Extensive Variability in Vasoactive Agent Therapy

Pei

Ma²,

et al. 2015

Chinese Medical Journal

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Background:Inconsistencies in the use of the vasoactive agent therapy to treat shock are found in previous studies. A descriptive study was proposed to investigate current use of vasoactive agents for patients with shock in Chinese intensive care settings.Methods:A nationwide survey of physicians was conducted from August 17 to December 30, 2012. Physicians were asked to complete a questionnaire which focused on the selection of vasoactive agents, management in the use of vasopressor/inotropic therapy, monitoring protocols when using these agents, and demographic characteristics.Results:The response rate was 65.1% with physicians returning 586 valid questionnaires. Norepinephrine was the first choice of a vasopressor used to treat septic shock by 70.8% of respondents; 73.4% of respondents favored dopamine for hypovolemic shock; and 68.3% of respondents preferred dopamine for cardiogenic shock. Dobutamine was selected by 84.1%, 64.5%, and 60.6% of respondents for septic, hypovolemic, and cardiogenic shock, respectively. Vasodilator agents were prescribed by physicians in the management of cardiogenic shock (67.1%) rather than for septic (32.3%) and hypovolemic shock (6.5%). A significant number of physicians working in teaching hospitals were using vasoactive agents in an appropriate manner when compared to physicians in nonteaching hospitals.Conclusions:Vasoactive agent use for treatment of shock is inconsistent according to self-report by Chinese intensive care physicians; however, the variation in use depends upon the form of shock being treated and the type of hospital; thus, corresponding educational programs about vasoactive agent use for shock management should be considered.

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Evaluation and Management of Shock States

Cited by 30 publications

References 160 publications

Evaluation of volume status in a prehospital setting by ultrasonographic measurement of inferior vena cava and aorta diameters

Evaluation of volume status in a prehospital setting by ultrasonographic measurement of inferior vena cava and aorta diameters

Assessment of patients presenting in shock at emergency department in a tertiary care teaching hospital

Extensive Variability in Vasoactive Agent Therapy

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