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Shock

Shock

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Published by Om Lakhani
Medicinenotes.in Notes on Shock prepared by Dr. Om Lakhani, MD.
Medicinenotes.in Notes on Shock prepared by Dr. Om Lakhani, MD.

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Published by: Om Lakhani on Sep 29, 2013
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11/15/2013

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CRITICAL CARE MEDICINE (WWW.MEDICINENOTES.COM)
© DR. OM LAKHANI WWW.MEDICINENOTES.COM Page 1
SHOCK 
BY DR. OM LAKHANI , MD
IMPORTANT POINTS
 
These notes are made from Standard Textbook of Medicine
 
The current notes corresponds to Chapter 270 of Harrison’s Internal medicine
 
 
The Yellow shades refer to things you have to revise frequently (atleast once a week)
 
The Blue shades refers to concepts
 
The Pink shades refers to concepts that are not required for undergraduate level but usefulfor Postgraduate level.Q. What is Shock ?
 
It is syndrome arising because of Inadequate tissue perfusion. It is associated with MAP <60mm Hg.Q. What is the vicious circle of Shock ?Q. What are the major causes of Shock ? (classification of shock)1.
 
Hypovolemic shock2.
 
Cardiogenic shock
Hypovolumeiatissue injuryRelease of DAMPs -Danger associatedmolecular patternsInflammatorymediator releaseCapillary leakage
 
CRITICAL CARE MEDICINE (WWW.MEDICINENOTES.COM)
© DR. OM LAKHANI WWW.MEDICINENOTES.COM Page 2
3.
 
Septic shock4.
 
Neurogenic shock5.
 
Hypoadrenal shock6.
 
Traumatic shockQ. Which two organs must continuously receive blood supply ?Blood to brain and heart must continue despite Hypotension. Else they develop ischemia very fast.Q. Which blood vessels maintain the Systemic vascular resistance ?
 
Arterioles are responsible for maintaining the systemic vascular resistance.
 
Alpha1 receptor present cause vasoconstriction while beta 2 sympathetic receptors causevasodilatation.
 
When there is reduced pressure, the blood to brain and heart is maintained while blood toother organs is impaired.Q. Which is the key process that ultimately causes Organ Failure ?
 
Impairment of Microcirculation occurs in later stages of shock. This is responsible for theOrgan failure that results from shock.Q. Which hormones are increased in shock ?1. Cortisol (because of Increase ACTH release)2. Glucagon3. Catecholamines4. Vasopressin5. AldosteroneCLINICAL PEARL : Increase LACTATE/PYRUVATE RATION is a marker of Hypoxia in shockQ. True or false- Serum triglycerides are reduced in Shock ?False- Triglycerides are typically increased in Shock.
Q . What agent is called as “endogenous Pyrogen” ?
 IL-1beta is marked as endogenous pyrogen
MANAGEMENT OF SHOCK 
 
CRITICAL CARE MEDICINE (WWW.MEDICINENOTES.COM)
© DR. OM LAKHANI WWW.MEDICINENOTES.COM Page 3
Q. In which condition is Swan Ganz (Pulmonary arterial catheter) put in case of shock ?Conditions were PAC is put are :1.
 
Shock with on-going blood loss2.
 
Cardiac dysfunction3.
 
Rapid fluid shiftsQ. What are the parameters required to determine the type of Shock ?To characterize the type of Shock you are dealing with you have to measure1.
 
CVP2.
 
PWCP (approximately equal to LA pressure)3.
 
Systemic vascular resistance4.
 
Venous Oxygen saturationQ. In which type of Shock CVP and PCWP are increased ?1.
 
Cardiogenic shock2.
 
Sometimes in Septic shockQ. In which type of Shock is Cardiac output increased ?1. Early septic shock2. Shock with Liver failureQ. In which type of shock is SVR reduced ?1. Early septic shock (hyperdynamic phase of septic shock)2. Hypoadrenal shock
HYPOVOLEMIC SHOCK 
Q. True or false Hypovolemic shock is the most common cause of shock ?
 
True.Q. What are the clinical features of reduce volume20% reduction of Circulating volume
 
Mild tachycardia
 
Mild Anxiety

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