What is the treatment for shock in ICU?

Question

(I mean specifically inotropes/drugs pls)

- Hypovolemic = replace volume/electolytes, then?

- Cardiogenic = which inotropes/chromotropes?

- Septic = Antobiotic + supportive measurements then what inotropes/etc favored?

- Anaphylactic = Adrenaline infusion then?

Spinal = What is the treatment / drugs?

Thanks

Answer 1

Ole gave a very comprehensive answer, but I'm afraid I disagree with a few of his drug choices.  Here is my take:

Hypovolemic:

- the most important thing is to replace volume

- so we give colloids (blood products and synthetics like Pentaspan) as well as crystalloids (IV solutions like normal saline and ringer's lactate) with the aid of rapid infusers (which also heat the fluid to avoid hypothermia)

- best venous access: multiple large bore IVs (NOT central line, unless it's a Cordis)

- while the colloids and crystalloids are being infused, the blood pressure may have to be supported with pressors like dopamine (at alpha doses) and vasopressin

- in general, the heart is already in overdrive, so we avoid inotropes like dobutamine

Cardiogenic:

- technically, external compression on the heart from things like tension pneumothorax is considered "obstructive shock", not cardiogenic: http://www.aic.cuhk.edu.hk/web8/shock.ht...

- cardiogenic shock is due to failure of the heart itself, so this is where inotropes (like dobutamine) are important; norepinephrine is mainly a pressor, not inotrope

- we often insert an intra-aortic balloon pump (IABP) to augment the pumping of the heart

Septic Shock:

- again, the heart is usually in overdrive already, so you mainly want pressors, not inotropes

- phenylephrine and norepinephrine are "purer" pressors than dopamine (which has some inotropic properties, especially at higher doses)

- often, if meeting the appropirate criteria, the patient will also be given steroids and activated Protein C

- antibiotics are obviously needed, but will not help immediately (may even make things worse through lysis of bacteria)

Anaphylactic:

- adrenaline (which is the same thing as epinephrine -- I'm not sure why Ole listed it twice) is good, as are steroids

- often, there is a vasodilatory component, so pressors (phenylephrine, norepinephrine, vasopressin, and dopamine at lower doses) are helpful

Spinal shock

- another vasodilatory shock

- as Ole mentioned, lots and lots of fluids and pressors as needed

Hope this helps.

Answer 2

Treatment is individual, but some general treatment below

Hypovolemic shock

* Find and stop the bleeding

* Replace volum with colloids and crystalloids

* Give oxygene

* Give pressor, ie dopamine, vasopressin, or dobutamine

Cardiogenic shock

* Give oxygene

* Correct pneumothorax

* Increase contractility by dopamine, norepinephrine, or vasopressin

Septic shock

* Give volume

* Identify infection

* Early and extensive antibiotics

* Pressor: Dopamine, norepinephrine

Anafylactic shock

* Identify and remove antigen

* Anthistamins

* Adrenaline

* Volume replacement

* Pressor: Dopamine or epinephrine

* Give oxygene

Spinal shock

* Large volume replacement

* Pressor  ie noradrenalin