ABC - Approach

Shock

BY:
Mohammed Nassef
Lecturer of anesthesia and
intensive care
 • Objectives:
 Define shock.

 Types.

 Pathophysiology.

 Diagnosis.

 Management.
ABCDE
•Airway
Approach
•Breathing
•Circulation
•Disability
•Exposure
 Lactic acidosis Low UOP

Tachycardia Unconsciousness

Shocked ?????
Delay CRT Hypoxia

Hypotension Anemia
 Tissue Perfusion

The amount of blood reaching the tissue of interest and is

measured in units of ml/100g-min.
Defective Tissue perfusion

Ischemia hypoperfusion Shocked

Stroke volume × heart rate
 Preload

COP = HR × (EDV – ESV)

 Hemorrhage

GIT

Third space

Early Burn
 Initial
resuscitation
 1-Hemostatic resuscitation

Compression Tranexamic acid Pelvic binder

 Initial
resuscitation
 2-Hypotensive Resuscitation

 Systolic of 90 mmHg.

 Mean more than 60 mmHg.

 TBI: systolic more than 110 mmHg – Mean more than

90 mmHg.
 Peripheral Cannula

CVC

Interosseous
Which Type ?????????
Quantity ???????
Frank Staling Law
 When to
transfuse blood
products???

Goal directed therapy

 Initial resuscitation

Transient - Not responder

Responsive
responder
3-Damage control
surgery
4- Radiological Intervention
 • Case scenario (1)

Male, 27 yrs, stab wound to the left

hypochondrium, unrecorded blood
pressure, agitated, pale, delay
capillary refill, tachypnea, decrease
air entry to the left hemithorax,
muffled heart sounds, congested neck
veins???
 • Case scenario (2)

Male, 23 yrs., penetrating stab

wound to the neck, arrived at the
E.R, thready pulse, unconscious,
unrecorded blood pressure, pale,
pulsating active bleeding from the
wound??
 Causes:
• Heart failure.

• Ischemic heart disease

• Arrhythmia.
 Inotropes:

• Adrenaline.

• Dobutamine.

• Dopamine.

• Milrinone.
 Mechanical:

• Aortic Pump.

• Lt.vad.

• Cardiac resynchronization.
 Surviving Sepsis Campaign

https://www.sccm.org/SurvivingSepsisCampaign/Home
Eliminate Septic Focus.

Antibiotic Antifungal

surgery
 Pulmonary embolism.

 Pneumothorax.

 Cardiac tamponade.