Klinisk Biokemi i Norden · 4 2013
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Diagnostic investigation
during CPR
Therapy
Further therapy-related
sampling
Hypoxia
Clinical diagnosis
SpO2
ABG
100% oxygen
ABG
Hypothermia
Clinical diagnosis
Temperature (rectal, esop-
hageal, bladder)
Glucose
Prolonged resuscitation
Rewarming
TSH, T3, T4
Na, K, Creatinine
INR, aPTT
Hypovolemia
Clinical diagnosis
Ultrasound
Glucose
Transfusion
Rehydration
Inotropes
Hb, TPK, INR, aPTT
Na, K, Creatinine
ABG
Lactate
Hypo-/hyperpotassemia,
electrolyte disorders
Na, K, ionCa, Mg, Crea-
tinine
Urea
ABG
Lactate
Glucose
Bicarbonate
Corticosteroids
Goal-directed therapy
Cardiac tamponade
Ultrasound
Clinical picture
ECG
Evacuation, pericardio-
centesis
Hb, INR, aPTT
ABG, lactate
Tension pneumothorax Clinical picture
Ultrasound
(X-ray)
Needle-evacuation
Thoracocentesis
INR, aPTT
Thromboembolism/
Pulmonary embolism
Clinical picture
Ultrasound
ECG
Thrombolysis
Invasive therapy/operation
INR, aPTT, Hb, TPC, ABG
Toxic
Clinical picture
ECG
ABG
Na, K, ionCa Creatinine,
Tox-screening
Glucose
Prolonged CPR
Goal-directed therapy/
antidotes
Elimination (activated
charcoal, gastric lavage,
intestinal lavage, dialysis)
Supportive therapy
Methanol
Ethanol
Ethylenglycol
Isopropylalcohol
Myoglobin
Urinary microscopy
Table 2.
The 4 H´s and the 4 T´s.
Shock
Shock might be defined as a state of circulation ina-
dequate to provide the oxygen/nutrition required to
maintain cellular metabolism. Untreated shock must
be considered to be a life-threatening condition, and
must be addressed properly. Shock can be classified in
several ways – functional or causative. The functional
classification is according to distributive, cardiogenic,
hypovolemic, endocrine and occlusive, whilst the
causative classification is cardiogenic, hypovolemic,
anaphylactic, septic and neurogenic.
Shock has to be treated aggressively and the under-
lying cause for the patient´s state of shock must be
sought as fast as possible. Table 3 gives an overview
about the different forms of shock, the adequate
investigations at the ED and the treatment required.
