48 |
Klinisk Biokemi i Norden · 4 2013
Clinical picture
Therapy
Investigation
Potential differentials
Septic shock
(distributive)
Tachycardia
Low BP
Low urinary output
Antibiotics
Fluid resuscitation
Inotropes
Adequate oxygenation
Antipyretics
Steroids
ABG
Lactate
WBC-differential
CRP, PCT
Na, K, Creatinine
Urinary dipstick
Microbiology/PCR
Chest X-ray
Ultrasound
Consider lumbal pun-
cture (Liquor Glucose,
lactate, WBC, prote-
ins, PCR for virus and
bacteria)
Thyreotoxicosis
DKA
Anaphylactic shock
Intracranial hemorr-
hage
Anaphylactic
shock (distri-
butive)
Quincke-oedema
Pulmonary obstruc-
tion
Tachycardia
Low BP
Low urinary output
Adrenaline
Adequate oxygenation
Secure airway
Fluid resuscitation
Antihistamines
Corticosteroids
ABG + lactate
Creatinine, Na, K
WBC-differential
Septic shock
Hereditary angioneu-
rotic oedema
Eosinophilic syndro-
mes
Mastcell-leukemia
Neurogenic
shock (distri-
butive)
Low BP
Relative bradycardia
Peripheral areflexia
Bladder atony
Intestinal paralysis
Rectal incontinence
Fluid-resuscitation
Neurosurgical consul-
tation if operation
Spinal X-ray
Hb, TPK
INR, aPTT
Na, K, Creatinine
Blood-group
Coomb’s test
Hypovolemic Low BP
Tachycardia
Decreased turgor
Low urinary output
Fluid resuscitation
In case of hemorr-
hage, hemostasis
ABG, lactate
Na, K, Creatinine
Urea
Hb, Hc, TPC
Blood group
B-glucosis
Emergent ultrasound
Septic shock
Anaphylactic shock
Cardiogenic Low BP
Pulmonary oedema
Treatment of causative
disease
Diuretics
Opioids
Oxygen
Respiratory support/
NIV Inotropics
Cardiac devices
Troponines
D-Dimer
PCT
Na, K, Creatinine
ABG, lactate
Cardiac ultrasound
Chest X-ray
AMI
Acute valve-insuffi-
ciency
PE
Volume overload
(renal failure)
Intoxication
Table 3.
Different forms of shock with adequate investigations.
Unconsciousness
An unconscious patient is a potentially life threatened
patient. An overview of potential causes of unconsci-
oussness and the relevant sampling in the patient is
shown in the following table 4.
