Summary Writer: Nathan Trist
Editor: James Edwards
Interviewee: Rob Hislop
Bruce Way talks to Dr Rob Hislop about an approach to the management of undifferentiated shock in the first of a two part series.
Robert Hislop is a senior intensivist at Royal Prince Alfred Hospital and the director of the ICU at the Mater Hospital (North Sydney). He is a Clinical Lecturer at the University of Sydney with a strong interest in medical education. He is also an active volunteer with Open Heart International.
With Dr Rob Hislop Intensive Care Unit consultant, Royal Prince Alfred Hospital and Dr Bruce Way, Emergency Physician and Director of Prevocational Education and Training at Prince of Wales Hospital, New South Wales, Australia
Shock is a state where there is inadequate perfusion of tissues. Causes can be broadly categorised into vasodilatory, cardiogenic, hypovolaemic and obstructive shock. These categories and an approach to undifferentiated shock will be explored here.
Case 1 – The scout nurse rings you from theatre on behalf of the surgical registrar who is asking you to review a patient for her on the surgical ward. The message you get is that the patient has undergone a thoracic biopsy that day which was a minor procedure. She is ‘a bit hypotensive’ and the surgical registrar has asked you to have a look at the patient and chart some fluids.
On review of the patient’s notes she is a 43 year old lady previously well, being investigated for fluctuating fever and cough, with an outpatient CT chest showing a mediastinal mass.
Your review reveals BP 90/55, HR125 and a patient who seems confused and not aware she is in hospital.
As the cause of hypotension and tachycardia can be varied in this patient your questions, history and examination should aid in determining the causes.
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