Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- cognição alterada/agitação
- hipotensão
Other diagnostic factors
- taquipneia
- taquicardia
- tempo de enchimento capilar prolongado
- oligúria
- fraqueza muscular
- cianose
- membros frios
- evidências de trauma
- erupção cutânea petequial
- dor torácica
- febre
- dor abdominal
- estase jugular
- edema periférico
- ausência de murmúrios vesiculares de um lado do peito
- desvio da traqueia
- sons cardíacos silenciosos
- paralisia flácida dos membros inferiores
- sopro cardíaco
- bexiga distendida
- edema facial e na língua
- erupção cutânea urticariforme
- dor na pelve/sangramento vaginal em mulheres em idade fértil
Risk factors
- avanço da idade
- comorbidades
- infarto do miocárdio
- cardiomiopatia
- doença da valva cardíaca
- arritmias
- trauma
- hemorragia digestiva
- aneurisma roto da aorta abdominal
- queimaduras/golpe de calor
- perdas gastrointestinais: diarreia e vômitos
- pancreatite
- sepse
- anafilaxia/intoxicação
- lesão espinhal ou do tronco encefálico
- doença endócrina
- embolia pulmonar
- tamponamento cardíaco
- novo medicamento (choque anafilático)
Diagnostic investigations
1st investigations to order
- lactato (gasometria arterial)
- gasometria
- Hemograma completo
- ureia e creatinina
- eletrólitos séricos
- estudos de coagulação (razão normalizada internacional [INR], tempo de tromboplastina parcial [TTP] ativada)
- glicose sanguínea
- anion gap
- proteína C-reativa
- procalcitonina
- eletrocardiograma (ECG)
Investigations to consider
- radiografia torácica
- Ultrassonografia realizada de acordo com o protocolo Focused Assessment with Sonography for Trauma
- ecocardiografia
- dióxido de carbono ao final da expiração (capnografia)
- ultrassonografia do tórax
- ultrassonografia do abdome
- TC do tórax, abdome e pelve
- angiografia pulmonar por tomografia computadorizada
- urinálise e teste de gravidez urinário
- ultrassonografia pélvica
- radiografia de ossos longos
- radiografia da coluna
Treatment algorithm
todos os pacientes
Contributors
Authors
Samuel J. Stratton, MD, MPH
Professor
Fielding School of Public Health
David Geffen School of Medicine at UCLA
Los Angeles
Deputy Health Officer
Orange County Health Care Agency
Health Disaster Management/Emergency Medical Services
Santa Ana
CA
Disclosures
SJS declares that he has no competing interests.
Acknowledgements
Dr Samuel J. Stratton wishes to gratefully acknowledge Dr Christoph Pechlaner and Dr Christian Wiedermann, previous contributors to this topic.
Disclosures
CP and CW declare that they have no competing interests.
Peer reviewers
Patrick Nee, FRCP, FRCS, FCEM
Consultant in Accident & Emergency Medicine
St Helens & Knowsley Hospitals NHS Trust
Whiston Hospital
Prescot
UK
Disclosures
PN declares that he has no competing interests.
James Brown, MD, MMM
Vice-Chair and Program Director
Wright State University Department of Emergency Medicine
Dayton
OH
Disclosures
JB declares that he has no competing interests.
References
Key articles
Cecconi M, De Backer D, Antonelli M, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014 Dec;40(12):1795-815.Full text Abstract
Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021 Nov;47(11):1181-247.Full text Abstract
McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-3726.Full text Abstract
Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022 May 3;79(17):e263-421.Full text Abstract
van Diepen S, Katz JN, Albert NM, et al. Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association. Circulation. 2017 Oct 17;136(16):e232-68.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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