Shock can be seen at three different phases. Compensated shock; which just maintains that the patient, through compensatory mechanisms, is able to maintain a blood pressure. It doesn’t mean that they are able to maintain perfusion to the tissues. It just means that they are not yet hypotensive. A de-compensated shock means that they are no longer able to maintain a blood pressure and at some phase your patient is going to enter irreversible shock, which – no matter what you do at that point – your patient is destined to die. Obviously you would like to see patients in the early phases of shock and not in the later phases. There is an easy way to remember normal blood pressures, which is in your handout. Systolic pressure should be greater than 60 mmHg up to a month, 70 from a month to a year, and 70+ the quantity two times the age, if you are above a year of age. Obviously if you are 60-year-old your normal blood pressure should not be 190. These are minimal blood pressures, these are not normal blood pressures. They are good estimates of 5th percentile. So if you are below these you are hypotensive.
What are the shock patterns that you can see in patients? We are going to talk about these a little bit, each individually; hypovolemic shock, cardiogenic shock, septic shock and distributive shock. Hypovolemic shock; you would like to have some sort of a history suggesting that your patient is hypovolemic. Lack of intake, vomiting, diarrhea, something that would decrease their volume status. Tachycardia is very sensitive for hypovolemia. That is, if you are hypovolemic you will undoubtedly be tachycardic. Some children will get tachycardic just seeing your approach. So it’s not a very specific indicator, but it is sensitive. Poor perfusion, the body’s compensation to hypovolemia, is to vasoconstrict peripheral tissue beds so you will see cold, cool extremities with delayed capillary refill. And since your intravascular volume is small, your heart size will be small and your liver will be small, which may be discernible on physical examination.
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