| Anemia (dependent on the hemoglobin level and each patient`s comorbidities |
Drop in CaO2
|
Can compensate with increase in HR |
Improve the supply/Hb production (if possible): correction of the anemia (see the possibility of iron, erythropoietin, etc.) |
| Severe anemia (hemorrhagic shock) |
Drop in CaO2 dependent on the hemoglobin level |
Can compensate with increase in HR, however hypotension and signs of bad clinical perfusion are evident (drop in diuresis, cold and clammy skin, alteration in awareness, etc.) |
Consider concentrated red blood cell transfusions and/or volume replacement (escalation of therapy depends on the degree of shock - from I to IV) |
| Drop in oxygenation (e.g.: lack of intubation, hypoxemic respiratory failure) |
Drop in CaO2
|
Initial increase in HR as compensatory mechanism; if not resolved, drop in SV and CO - bradycardia and cardiorespiratory arrest |
Improve DO2 depending on underlying cause |
| Tachyarrhythmia |
Initially it is unaffected in well-oxygenated patients |
Pathologic increase in HR with impairment of diastolic filling - drop in SV and CO. Can evolve to cardiorespiratory arrest |
Treat the arrhythmia according to Advanced Cardiac Life Support guidelines of the American Heart Association |
| Bradyarrhythmia |
Initially it is unaffected in well-oxygenated patients |
Pathologic drop in HR (impairment of coronary perfusion) can lead to ischemia, drop in CO and even cardiorespiratory arrest |
Treat the arrhythmia according to Advanced Cardiac Life Support guidelines of the American Heart Association (drugs or pacemaker) |
| Cardiogenic shock |
Initially it is unaffected in well-oxygenated patients |
Patient may present with impaired CO, SV or both |
Depending on the cause (inotropic agents, antiarrhythmics or invasive ventricular assist devices (such as IAB, ECMO) may be necessary |
| Obstructive shock |
CaO2 may drop depending on the cause (e.g.: massive pneumothorax or hemothorax) |
Drop in CO due to reduced venous return or filling of the right ventricle (tamponade for example) and consequent drop in SV |
Make a correct diagnosis and intervene |
| Distributive shock |
Initially it is unaffected in well-oxygenated patients |
Vasoplegia may lead to a drop in arterial pressure with a reduction in venous return and SV; Although the CO may be hyperdynamic in some situations |
Make a correct diagnosis and intervene |
| Hypothermia |
Initially it is unaffected in well-oxygenated patients - in situations of deep hypothermia (a rare condition), the CaO2 may be augmented due to an increase in solubility of O2 in the liquid (plasma) |
Initially there is a compensatory increase in the CO to attempt to supply the organism and maintain homeostasis; if it persists the HR and CO drop |
Gradual rewarming |
| Sedation/analgesia |
Initially it is unaffected in well-oxygenated patients.
In sedated and badly oxygenated patients, it may lead to a drop in the CaO2
|
Well indicated, analgesics and sedation normally promote anxiolysis, with consequent reduction in HR, and improvement in diastolic filling, SV and CO. Excessive sedation or inappropriate use of sedative drugs can cause hypotension, a drop in SV and consequently a drop in CO |
Adequate analgesia and sedation for each nociceptive stimulation |
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