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  • Sources: MacLaren R, Rudis MI, Dasta JF. Use of Vasopressors and Inotropes in the Pharmacotherapy of Shock. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=7974733 and Erstad BL. Hypovolemic Shock. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=7975001. Both accessed July 17, 2012.

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  • Acute, generalized state of inadequate perfusion of critical organs associated with systolic blood pressure (SBP) <90 mm Hg or reduction of at least 40 mm Hg from baseline with perfusion abnormalities despite adequate fluid resuscitation.

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  • Intravascular volume deficit (hypovolemic shock)
    • Blood loss due to:
      • Trauma
      • Surgery
      • Hemorrhage
    • Plasma loss due to fluid sequestration or loss
    • Dehydration
      • Excessive insensible fluid loss
      • Diuretic overuse
      • Severe vomiting or diarrhea
  • Myocardial pump failure (cardiogenic shock)
  • Peripheral vasodilation (septic, anaphylactic, neurogenic shock)

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  • Fall in blood pressure (BP) compensated by increased sympathetic outflow, activation of renin–angiotensin system, and other humoral factors that stimulate peripheral vasoconstriction.
  • Vasoconstriction redistributes blood away from skin, skeletal muscles, kidneys, and GI tract toward vital organs (e.g., heart and brain) to maintain oxygenation, nutrition, and organ function.
  • Metabolic lactic acidosis develops from tissue ischemia and causes vasodilation, further exacerbating impaired cardiovascular function.

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  • Incidence unknown.
  • More than 100,000 deaths in United States each year due to injuries that often involve bleeding.

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  • Surgery
  • Trauma
  • Hemorrhage
  • Infection
  • Heart failure
  • Burns
  • Dehydration
  • Anaphylaxis

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Signs and Symptoms

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  • Hypovolemic shock:
    • Thirst
    • Anxiousness
    • Weakness
    • Lightheadedness
    • Dizziness
    • Reduced urine output
    • Dark yellow–colored urine
  • Signs of volume loss:
    • Tachycardia (>120 beats/min)
    • Tachypnea (>30 breaths/min)
    • Hypotension (SBP <90 mm Hg)
    • Mental status changes or unconsciousness
    • Agitation
    • Normal or low body temperature with cold extremities
    • Decreased capillary refill
  • Reduced cardiac index (CI <2.2 L/min/m2)

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Means of Confirmation and Diagnosis

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  • Use noninvasive and invasive monitoring (Table 1), medical history, clinical presentation, and laboratory findings to confirm diagnosis and identify underlying cause.

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Table Graphic Jump Location
Table 1. Hemodynamic and Oxygen (O2)-Transport Monitoring Parameters

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