47 years old with hypotension, lactic acidosis, and atrial fibrillation, Your diagnosis?
0%Distributive shock
0%Cardiogenic shock
0%Hypovolemic shock
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Hemodynamics Management
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From the advance monitoring picture showed Map 79 , BP 141/61, CO 7l/min,CI7.0, SVi 91, HR 77/min,SVV 28%, PPV 29%, VO2i 11 ( very low), SVRi is 826 dsm2/cm5. Hb , SpO2, DO2i, PSi values are missing,
SVV 28% and PVV 29% means fluid responsive are strong predictives . SVRi are low while normal value is 1900 to 2400 dynes s m2/cm5.
Conclusion: High PPV and high SVV are predictive of fluid responsive parameters while SVRi is low indicator of vasodilation ( low after load ) indicates distributive shock syndrome. Low O2 consumption value means hypothermic which is common in distributive shock while hypovolumic and cardiagenic shock should be high .
IVC is not collapsing and echo showed good contractility .
Hopefully Dr. Mazen will encourage me as this advance monitoring is not available in our institute.