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S. Sunatrio Department of Anesthesiology, Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta - Indonesia Treatment of Shock. MANAGEMENT OF SHOCK Definition of shock Shock is a state in which there is inadequate blood flow to the tissues to meet demand. The use of an intra-arterial catheter is helpful in managing patients in cardiogenic shock. Resuscitation should be early and vigorous. Fluid administration should be considered even in cardiogenic shock resulting from myocardial infarction; patients are commonly diaphoretic, and relative hypovolemia may be present . Pharmacologic support of the patient with cardiogenic shock plays a major role in clinical management. ABC O2 100% at high flow rate Intubation and MV Improve circulation and DO2 Empiric Antibiotic (Sepsis) Shock and hypotension often co-exist, BUT a normal blood pressure DOES NOT exclude the diagnosis of shock. This chapter discusses the assessment and management of hypovolemic shock. 5. A patient who is in hypovolemic shock has the following clinical signs: Heart rate 120 beats/minute, blood pressure 80/55 mmHg and urine output 20ml/hr . the development and cause of cardiogenic shock to prevent the associated high morbidity and mortality (4). Inotropes Agent Site of Action Dose Mcg/kg/min Effects Dopamine Dopaminergic Beta Alpha < Beta 1-3 5-10 11-20 Renal vasodilation Inotrope/vasoconstriction in order to increase BP Increase peripheral. Nitroprusside is a vasodilator that works by relaxing the muscles in your blood vessels to help them dilate (widen). Dopamine has traditionally been the drug of choice, owing to its vasopressor and inotropic activity. Diuretics, inotropic agents, and vasodilator drugs all have a place in the management of selected patients with low output states and cardiogenic shock following myocardial infarction. DRUGS USED IN SHOCK MANAGEMENT Inotropes –cardiac support Vasopressins (pitressin) Steroids 21. Beyond initial management, therapy is tailored to the cause of the distributive shock. Vasodilatory shock, vasogenic shock, or vasoplegic shock is a medical emergency belonging to shock along with cardiogenic shock, septic shock, allergen-induced shock and hypovolemic shock.When the blood vessels suddenly relax, it results in vasodilation.In vasodilatory shock, the blood vessels are too relaxed leading to extreme vasodilation and blood pressure drops and blood flow becomes very low. In septic shock, aggressive fluid management is generally necessary. C: Furosemide could greatly alter the usual presentation of a patient with hypovolemic shock in a negative way as this drug promotes passage of fluids through the urine. Hypovolemic shock is often seen in patients with severe blunt trauma who have suffered from blood circulation inadequate to maintain oxygen delivery to multiple organs. Hypovolemic shock is a medical emergency in which blood volume drops to a dangerous level. It occurs when the body loses excessive amounts of water and salt. For hypovolemic, obstructive, and distributive shock, fluid resuscitation is the first step in management. Management of Hypovolemic Shock: Volume and Pharmacologic Therapy. Initial treatment. Septic Shock. Clinical evidence of organ hypoperfusion include: ... Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. The early recognition and prompt management of hypovolemic shock in patients with multiple injuries are mandatory to improving prognosis and patient conditions. Norepinephrine As with hypovolemic shock, administer 20 mL/kg of fluid as a bolus over 5 to 10 minutes and repeat as needed.