Professional Documents
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Shock
Shock
A Cellular
B Micro vascular
C Systemic
D Ischemic-reperfusion syndrome
PATHOPHYSIOLOGY
A. CELLULAR
tissue perfusion
0
2
B. MICROVASCULAR
Tissue ischemia leads to
A. Hypovolumic Shock
B. Cardiogenic Shock
C. Obstructive Shock
D. Distributive Shock
E. Endocrine Shock
A. Hypovolumic Shock
Circulatory volume
Causes
Haemorrhage
Poor fluid intake
Excessive fluid loss
Vomiting
Diarrhea
Polyuria
Burn
Third space loss (Int obs + Pancreatitis)
B. Cardiogenic shock
Cardiac pump failure
Causes
M.I
Dysrhythmias
Vascular disease
Cardiomyopathy
Blunt myocardial injury
C. Obstructive shock
Reduction in preload leads to obstruction in
cardiac filling
Causes
Cardiac tamponade
Tension pneumothorax
Massive pulmonary embolism
Air embolism
D. Distributive shock
It describes Pattern of Cardio Vascular responses
characterising a variety of conditions
including:
Septic shock
Anaphylaxis
Spinal cord injury
E. Endocrine shock
Present as combination of hypovolumic,
cardiogenic and distributive shock
Causes
Hypothyroidism = HR & COP
Hyperthyroidism = COP failure
Adrenal insufficiency= Addison disease
Hypovolumic Cardiogenic Obstructive
Distributive
COP
VASCULAR
RESISTENCE
VENOUS
PRESSURE
MIXED
VENOUS O2
SATURATION
BASE DEFICIT
CLINICAL FEATURES
OF
SHOCK
Compensated Mild Moderate Severe
Lactic acidosis + ++ ++ +++
MILD SHOCK
Tachycardia, tachypnoea and urine output
Mild anxiety
BP maintained
Periphery cool + sweaty
SEVERITY OF SHOCK
&
CLINICAL FEATURES
MODERATE SHOCK
Urine output (<0.5ml/kg/h)
BP -
Patient is drowsy
SEVERE SHOCK
Tachycardia
Hypotension
Anuria
Patient unconscious
Respiration laboured
Consequences
Unresuscitatable shock
Long period of shock unresuscitable
Cellular ischemia cell death
Myocardial depression
Death results
Multiorgan Failure
Period of shock is limited, intervention is timely then
patient recover.
Results of prolonged systemic ischemia and reperfusion
injury is end organ damage and multiorgan failure
(MOF)
MOF in defined as two or more failed organs.
Lung – Acute respiration distress syndrome
Kidney – Acute renal insufficiency
Liver – Acute liver insufficiency
Clotting – Coagulopathy
Cardiac – Cardiovascular failure
Resuscitation:
A. Airway
B. Breathing
C. Circulation
Minimum
ECG
Pulse Oximetry
Blood pressure
Urine output
Additional modalities
CVP
Invasive BP
Cardiac output
Base deficit and serum lactate
Endpoints of Resuscitation
Traditionally – pulse, BP, urine output.
OCCULT HYPOPERFUSION
State of normal vital signs and occult
underperfusion
manifested by :-
- Persistant lactic acidosis
Mixed venous oxygen saturation level
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