Acute Stabilization
Shock & Fluid Resuscitation
Acute Stabilization

Shock & Fluid Resuscitation

Hemodynamic profiles + fluid choices + transfusion thresholds.

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◆Hemodynamic differentiation

  • •Hypovolemic: ↓CI ↓PCWP ↑SVR; cool/clammy + flat JVP
  • •Cardiogenic: ↓CI ↑PCWP ↑SVR; cool + JVD; causes include inferior MI, myocarditis, blunt cardiac injury
  • •Distributive (sepsis/anaphylaxis): ↑/normal CI ↓PCWP ↓SVR; warm dry skin (peripheral vasodilation)
  • •Neurogenic shock: distributive variant from spinal injury — hypotension + BRADYCARDIA
  • •Obstructive (tension PTX, tamponade, massive PE): JVD + poor perfusion

◆Fluid choices

  • •0.9% NS: hypovolemia, sepsis, hypercalcemia, initial DKA
  • •Lactated Ringer's: trauma, burns (avoid hyperchloremic acidosis); AVOID in hyperkalemia
  • •Parkland formula (burns): 4 mL/kg × %TBSA; 50% in first 8 hr, 50% over next 16 hr
  • •Transfusion threshold: Hgb <7 in stable; emergent O-neg in hemorrhagic shock unresponsive to 2–3 L crystalloid

◆Selective IgA deficiency

  • •Most common primary immunodeficiency, often asymptomatic
  • •Recurrent sinopulmonary and GI infections (Giardia)
  • •Risk of life-threatening anaphylaxis with IgA-containing blood products

High-yield pearls

  • ◆Warm, dry skin + hypotension = distributive shock (sepsis/anaphylaxis)
  • ◆Spinal cord injury + bradycardia + hypotension = neurogenic shock
  • ◆Anaphylaxis → IM epinephrine FIRST line
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