Diagnosis and Treatment of Shock, August 12, 1999

Diagnosis and Treatment of Shock, August 12, 1999

1. Diagnosis

① Heart rate > 100 beats per minute; ② Cold extremities and pale, moist face; ③ Positive sternum compression test (reperfusion time > 2 seconds); ④ Skin showing mottling; ⑤ Decreased urine output; ⑥ Systolic blood pressure < 80 mmHg, pulse pressure < 20 mmHg; ⑦ Blood pressure drops by more than 30% compared to the original average. If two of items ①–③ or one of items ⑤–⑦ are present, the diagnosis can be confirmed.

2. Treatment

Aggressive resuscitation is required, aiming to escape the state of shock within 24 hours; otherwise, respiratory failure, renal failure, metabolic disorders, electrolyte imbalances, and severe infections will follow one after another, pushing the condition toward an irreversible state. Modern monitoring methods include: ① Measurement of central venous pressure and pulmonary capillary wedge pressure: the former is obtained by inserting a catheter into a peripheral vein and advancing it to the vena cava near the right atrium; the latter is measured using a balloon-floating cardiac catheter. ② Arterial pressure monitoring: arterial puncture and catheterization are used to directly measure intravascular pressure, while blood samples are simultaneously collected for blood gas analysis and biochemical indicators. ③ Insertion of a urinary catheter to record intake and output, with specimens taken for laboratory testing.