Question of ICU care posed by Prof JL Vincent in NEJM on what to monitor in this hypotensive patient. Here is a sample of the extraordinarily diverse answers given. 1. The hypotension is caused by distributive shock. Give antibiotics and normal saline IV. 2. Distributive shock; add SVO2 to monitoring 3. Add norepi + red blood cells to increase oxygen carrying capacity if hypotension persists. 4. Distributive but might also be hemorrhagic shock. Give norepi, vasopressin and then epi if needed if hypotension persists. 5. Place a Swann to measure cardiac index [output], venous filling pressures and peripheral resistance and increase central venous filling pressures from 6 to 12. 6. Add insulin but keep glycemic index above 75 to avoid hypoglycemia. 7. Keep SVO2 above 70 and give acetylcystine if hypotension persists. 8. Consider presence of raised intra-abdominal pressure and decompression if needed. 9. Call for procalcitonin levels and give dopamine and then dobutamine if hypotension persists. 10. The only primary care physician [GP] to respond said make a diagnosis! 11. The illustration accompanying the case report shows physicians scratching their heads trying to distinguish between distributive, hemorrhagic/hypovolemic, and cardiogenic shock.
Posted on: Wed, 30 Oct 2013 16:28:34 +0000
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