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shock (circulatory (vasodilatory (distributive) inc CO (dec SVR) (septic…

- - - - spinal cord injury above T4
        unopposed PNS (disrupted SNS)
        
        bradycardia
        dec preload
        (IV fluid to inc)
    - - tachy, nausea, vomiting
        abd pain w/ tenderness
        fever
        Hyperkalemia
        hyperpigmentation
        
        not responsive to pressor, fluid - glucocorticoid supplement may help
    - - septic shock
        
        qsofa >=2
        
        vasopressor refractory (just to keep MAP>65mmHg), lactate >2mmol/L
        
        G+ common in US (S. pneomiae, S. aureus)
        
        complications
        
        MODS
        
        Renal AKI
        
        metabolic acidosis
        
        prerenal: dec GFP hypoperfusion
        
        intrinsic: dead cells in urine (low output) (PAMP, DAMP, cyto, ROS etc.)
        
        pulmonary
        
        respiratory alkalosis
        
        ARDS (glycocalyx damage in endoC in p. cap -> exudate edema) refractory to sup O2 (fibrotic)
        
        PAMP, G- (endotoxin-> neuts, C5a)
        
        resp rate >30/min
        
        low PAWP (no cardiomeg)
        
        BNP >500pg/dl = cardiogenic p edema
        
        hematologic
        
        leukocytosis (left shift, demargination) C3a,IL1->immature neut release from bone marrow)
        
        thrombocytopenia
        
        low EPO/normocytic anemia
        
        DIC<- TF inc (schistocyte, bleeding from 3unrelated sites)
        
        GI
        
        mucosal erosion in duodenum, stomach & microthrombi in splanchnic -> bowel ischemia -> bacteremia
        
        BAD, worsens sepsis
        
        Neurological
        
        astrocyte dysfx
        
        microglia -> cns inflammatory cytokine; BBB leaky
        
        polyneuropathy
        
        endocrine
        metabolic
        
        CIRCI: Hypoglycemia
        
        fluid refractory. HPA axis or glucocor receptor fked
        
        TNF -> dec cortisol (block/damage adrenal)
        
        glucocorticoid may help
        
        hyperglycemia (insulin resistance)
        
        dec phagocytosis, inc cyto, inc ox stress, intrav coag -> super infection (Th2)
        
        keep sugar 140-180 may help
      - give NE not Epi
        (a1 to vasoconstrict/counter vasod)
  - - - dec CO, BP-> reflex recover
        
        (symptoms: anxiety, rising HR/cut pallor)
    - - dec CO, BP not recovered
        
        Ortho hypo
        
        organ hypoperfusion
        
        normal supine BP
        
        low urine output
        
        inc blood lactate, chest pain
        
        SNS hypA
    - - supine hypo
      - LDH/CK
        
        metabolic acidosis
        
        lactic acidosis -> systemic vasodilation
      - dec contractility (MDF)
      - intestinal ischemia
      - AKI, low urine output
      - ARDS