Professional Documents
Culture Documents
• Endpoints of Resuscitation
• Future Managements
Shock
• Shock is the imbalance between O2 delivery (DO2) and O2 consumption (VO2)
• However, their utility in the initial assessment of shock has been questioned and
these parameters alone are insufficient to define adequate resuscitation
Importance of Endpoints
• Shock is a spectrum of derangements
• Medications
• Optimisation of Hb
• Haemodynamic
• Metabolic
• Regional perfusion
Haemodynamic Endpoints
• The balance between DO2 and oxygen consumption (VO2) dictates tissue oxygenation
• Anaerobic metabolism results in producing only two ATP molecules and pyruvate,
rather than the 36 ATP molecules that are produced under aerobic conditions
• Pyruvate is converted to lactic acid, causing worsening lactic acidosis as the shock
state and prolonged severe tissue hypoperfusion persists
• Arterial Base deficit [mild 2-5; moderate 6-14; severe >14 mmol/L]
• pH [<7.1]
• Normal Gastric pHi is 7.4; pHi <7.32 is a good predictor of MODS and mortality
• Coagulation profile
• Thrombelastogram
• Thermal control
• Search for a single endpoint that works for all trauma patients, is unrealistic