MANAGEMENT OF SHOCK

Fluid Therapy
Endocrine
Inotropes
Systemic support
support
 MULTIPLE ORGAN FAILURE
Multiple organ failure or dysfunction
syndrome (MODS) is the clinical appearance of
a seemingly poorly controlled severe systemic
inflammatory reaction, following a triggering
event such as infection, inflammation or
trauma.
PATHOGENESIS MODS
SPESIFIC ORGAN INVOLVEMENT IN MODS
Respiratory system
PHYSIOLOGICAL EFFECTS OF MODS
 MANAGEMENT OF MODS
The best treatment for MODS remains prevention
This entails early aggressive resuscitation following
insult, avoidance of hypotensive episodes and
removal of risk factors, e.g. by early excision of
necrotic tissue, early fracture stabilization and
ambulation, and appropriate antibiotic usage
following drainage of sources of sepsis.
 TETANUS
Established tetanus is characterized by tonic,
and later clonic, contractions, especially of the
muscles of the jaw and face (trismus, risus
sardonicus), those near the wound itself, and
later of the neck and trunk.
 TREATMENT TETANUS
With established tetanus, intravenous
antitoxin (human for choice) is advisable.
Heavy sedation and muscle relaxant drugs
may help; tracheal intubation and ventilation
are the only options to treat respiratory
muscle involvement.
 FAT EMBOLISM SYNDROME
Fat embolism is a common phenomenon
following limb fractures. Circulating fat
globules larger than 10 m in diameter occur
in most adults after closed fractures of long
bones and histological traces of fat can be
found in the lungs and other internal organs.
 CRUSH SYNDROME
This is seen when a limb is compressed for
extended periods, e.g. following entrapment
in a vehicle or rubble, but also after prolonged
use of a pneumatic antishock garment.
 INTENSIVE CARE UNIT SCORING
SYSTEMS
The role of scoring systems in medicine has
expanded since the 1950s. There are now
many scoring systems catering for most organ
dysfunction, disease states, trauma and critical
illness.
 LIMITATION
Limitations and errors associated with the use
of the scoring systems include missing data,
observer error and interobserver variability.
Even the method of data collection (manual
data entry versus data collected automatically
from monitoring systems) leads to wide
variations in scores.