Collaborative Care: Specific Measures
Overall goal is to restore blood flow to the myocardium by restoring the balance between
oxygen supply and demand.
Definitive measures include thrombolytic therapy, angioplasty with stenting, emergency
revascularization, and valve replacement.
Care involves hemodynamic monitoring, drug therapy (e.g., diuretics to reduce preload),
and use of circulatory assist devices (e.g., intraaortic balloon pump, ventricular assist
The underlying principles of managing patients with hypovolemic shock focus on
stopping the loss of fluid and restoring the circulating volume.
o Fluid replacement is calculated using a 3:1 rule (3 ml of isotonic crystalloid for every
1 ml of estimated blood loss).
Patients in septic shock require large amounts of fluid replacement, sometimes as much
as 6 to 10 L of isotonic crystalloids and 2 to 4 L of colloids, to restore perfusion.
Hemodynamic monitoring and arterial pressure monitoring are often necessary.
Vasopressor drug therapy may be added and vasopressin may be given to patients
refractory to vasopressor therapy.
Intravenous corticosteroids are recommended for patients who require vasopressor
therapy, despite fluid resuscitation, to maintain adequate BP.
Antibiotics are early component of therapy and are started after obtaining cultures (e.g.,
blood, wound exudate, urine, stool, sputu