SHOCK

the
↳
abnormality of
circulatory system ,

resulting in inadequate organ perfusion d

-

tissue
-
oxygenation .

lab tests
↳ DX based on clinical findings a

① managing shock in trauma

-
→ tx based

on the probable cause .

② To identify the probable cause of shock

&
adjust TX accordingly .

↳ major types of shock :

↳ Blood loss pathophysiology
•
Hypodermic a
compensatory mechanism →
progressive
-

hemorrhagic ( external & internal ) vasoconstriction of cutaneous muscular ,

,

-
Severe bums visceral circulation to :
kidneys ,
heart ,
brain .

dehydration ( diarrhea DKA ) volume I HR IT in order to present

-

•
, →

CO : .

tachycardia Cslgns of circulatory

Cardio genio shock )
•
released
-

myocardial ischemia •
endogenous catecholamines ,→ IT peripheral
dysrhythmias vascular resistance → T DBP & I PP
-

CHF •
preserved venous return
by compensatory
-

cardio myopathies mechanism of contraction of the volume

of blood venous system

-

cardiac valve
problems in the .

I
elective way to restore adequate co end
,

•
Distributive ( vasodilatation ) organ perfusion & tissue Oz → to restore

semi neurogenic " "

get.in?:..:om:'.Ye..n :
" "" "
-
-

anaphylactic .

•
Inadequate perfusion → deprived subreste is

• obstructive normal cell metabolism → anaerobic

respiration
cardiac tamponade of lactic acid metabolic
production →
-

tension pneumothorax acidosis → end of organ damage a mob

-

PE • tx → the bleeding
stop
-
-

aortic stenosis Oz supply

-
-

- constrictive pericarditis -

ventilation

-
fluid resuscitation

↳ clinical evaluation t CRT

tachypnea

{
-
-
.
.

tachycardia dkral ↳ of Shock

¥ 't Recognition
-
-

• "

dpjg.in
narrow PP
tachycardia injured patient M
-

- -

-
f central , now , , .
> infant : 7160 dkral dingin
>
preschool : 7140

D mental
•

tate :
hypotension & >
puberty :
> 120

Status ,
I Urine output > adult : > 100

④ need to identify & stop the bleeding .

 ↳ Management of Hemorrhagic Shock

① ABCDE !
=

•
airway
e
breathing
provide supplementary Oz to maintain

saturation 795 't

02
.

of shock
circulation hemorrhagic control ↳ Stages :
• :

them outside ( compensated

-

bleeding →
stop by -

stage 1 1 non
progressive )
direct pressure ( may need maintain blood flow
putting . ↳ to heart &

tourniquet ) brain that vasoconstriction (

epinephrine )
-

surgical / angio embolization to ↳ anaerobic metabolism occurring

control Internal hemorrhage ↳ t maintain
peripheral blood flow → to

perfusion
disability neurological examination 4 maintain CO
tachycardia tachypney →
• :

↳
pale ,
cool , diaphoretic
•
exposure :
complete examination
-

prevent hypothermia → can exacerbate

-

stage Cdewmpensated I progressive )

z

loss
blood by contributing to ↳
Inability of the
body to sustain
acidosis adequate
wagulopathy & worsening perfusion .

↳ hypoxia ,
confused
,
disoriented

gastric dilation It distal pulse difficult

•
decompression :
4 Bp ,
to

usually occur in traumatic children locate .

/ veins
unexplained hypotension lool
cause ↳
-
may flat neck
, pale ,
, clammy
cardiac dysrhythmia ,
bradycardia skin , hypotension ,
oliguria
'
from X
vagal stimulation

gastric distention ( refractory 1 irreversible )

unconcious
patient → •

stage 3
-

can IT the risk of aspiration : .

4 body no longer to adjust the lost .

fatal complication .
↳ tissue
perfusion is negligible
: .
cellular necrosis due to lack of

•
urinary catheterization Oz tension

allow to see hematuria 4 heart function is

-

declined → slow d

urethral injury → contraindications multi

irregular system
-

; organ
.

failure starts to occur .

② e
z large bore 44-16 G ) IV in the

brachial 1 cephalic vein of each arms .

• Mh
i -2L bolus of normal N / RL

( warmed ) in 30 minutes

↳
prevent hypothermia
•
no response : crystalloid & consider

PRC transfusion .
( RBG )

•
consider common sites of internal bleeding

s
 SEPSIS
↳ life threatening organ dysfunction caused

dys regulated host response to

by a

dysfunction based
Infection → organ

on D of SOFA score 712 points .

*
septic shock → subset of sepsis where

sufficient / cellular l metabolic

circulatory e -

abnormalities A
substantially mortality .

↳ sepsis Y persisting hypotension

requiring vasopressin to maintain

MAP dos mmHg & serum lactate ↳ management

72 mmol IL ( 18 mgldl ) despite -

early recognition of sepsis d

adequate fluid resuscitation locate of

Investigate to source

infection

↳ ④ g
SOFA (22 criteria ) t further evaluation -

ensure
adequate organ perfusion

(
of possible infection dysfunction
I organ tx
priorities :
-

Maggie!
scorer t

knayiayosoea
n'

IIIa
→
mortality ri " "

;
'

. resuscitation
;
consider
ventilator
•
quick SOFA criteria : .
cultures →
empiric app .

• RR 722 ( minute antibiotics → consider broad

• altered mental status spectrum d

atypical coverage

•
SBP 1100 mmHg
•
source control → remove infected

foley / nursery for Ischemic gut

① Initial resuscitation ( first 6hm ) for

sepsis induced hypotension persisting

after initial third challenge 1
blood lactate a 4mmol IL

↳ maintain g Cup M IV
8-12 mmHg crystalloid /

colloids .
Goals
nya :

↳ maintain MAP 7,65 mmHg Y

epinephrine
Ihr
↳ UO 70.5mL 1kg
↳ mixed Oz saturation to 't .

① administer effective N microbial , Min

1st hour of recognition of

sepsis
③ Source control & infection
prevention
④ early nutritional support
 management of
↳ hypotension
fluids 4 of normal saline
① IV I -2L

over I -2 hrs .

central venous pressure maintained

at 8-12

② Maintain UO by given furosemide

③ maintain MAP 765 mmHg ,

SBP 790 mmHg

⑧ no response → kasih hydrocortisone

50mg N
every 6 hrs . for s -
7 days
label how,
tapering off

④ pnephylatiu heparin nation →

prevent
DVT . Kalan tidal bs pakai

heparin →
compression stocking