cardiovascular pathophysiology pharmacology_ treatment of shock
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7/21/2019 Cardiovascular Pathophysiology Pharmacology_ Treatment of Shock
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@Y Vbhroh`amacy-Vhtbapbyslamacy hed Trnhtonet ai Pba`g
Znhdlec; Hutaeaol` Enrvaus PystnoEatns
@mlel`hm; n-Ondl`len hrtl`mnsPba`g, @hrdlacnel`
Pba`g, Bypavamnol`
Pba`g, Pnptl`
Vrnphrnd hed prnsnetnd jy;Ohr` Lobatnp @rhy, O.D.
JOP / @G-@P Tnh`bnr
bttp;//www.lobatnpvlrtuhmonds`b.`ao/
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:
Pba`g (`lr`umhtary) Niin`ts ai lehdnquhtn pnriuslae ae `nmm iue`tlae
@ml`g ta nxphed
Pnn; Pba`g (`lr`umhtary. pdi)
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Pba`g, @lr`umhtary Dnilend
@lr`umhtary sba`g , `aooaemy geawe hs kust sba`g, ls hsnrlaus, mlin-tbrnhtnelec ondl`hm `aedltlae wbnrnlesuiil`lnet jmaad imaw rnh`bns jady tlssuns
Hs jmaad `hrrlns axycne hed eutrlnets hraued jady,rndu`nd imaw blednrs dnmlvnry ai tbnsn `aopaenets tatlssuns, hed `he stap tlssuns irao iue`tlaelec prapnrmy
Tbn pra`nss ai jmaad netnrlec tlssuns ls `hmmnd pnriuslae,
sa wbne pnriuslae ls eat a``urrlec prapnrmy tbls ls `hmmnd hbypapnriuslaehm (bypa ? jnmaw) sthtn
Pba`g; He Avnrvlnw VDI jy Ol`bhnm M. @bnhtbho, OD, Nrenst I.K. Jma`g, OD,Bawhrd C. Poltb, OD, Kabe T. Vraons, OD, Purcl`hm @rltl`hm @hrn Pnrvl`n,Dnphrtonet ai Purcl`hm Ndu`htlae, Armheda Znclaehm Ondl`hm @netnr Armheda,
Imarldh
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Tbn prajmno le sba`g
Hmtnrnd `lr`umhtary phrhontnrs
@aopraolsnd ol`ra`lr`umhtlae
Vnrslstnet snvnrn bypaxlh
Oumtlpmn arche ihlmurn
Irao; bttp;//www.`vpbhroh`amacy.`ao/`mlel`hm
tapl`s/bypatneslae.bto
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Ohle typns ai Pba`g
Yhsa`aestrl`tlvn
Trhuoh, jmnndlec, jurelec, lmnus (vamuone mass)
Vumoaehry nojamlso (lophlrnd `hrdlh` ilmmlec)
Oya`hrdlhm leihr`tlae (lophlrnd `hrdlh` `aetrh`tlae)
Yhsadlmhthtlvn
Hehpbymhxls, snpsls (ohmdlstrljutlae ai jmaad imaw)
Pplehm ondummhry lekury (vneaus paamlec)
Bypatbnrolh
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@mhsslil`htlae Le 8<3: Blesbhw hed @ax succnstnd
tbn iammawlec `mhsslil`htlae wbl`b ls
stlmm usnd tadhy Lt usns iaur typns ai sba`g;
8. bypavamnol`,
:. `hrdlacnel`,0. dlstrljutlvn hed
4. ajstru`tlvn sba`g
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@mhsslil`htlae(jhsnd ae `hrdlavhs`umhr `bhrh`tnrlstl`s, wbl`b whs
leltlhmmy prapasnd le 8<3: jy Blesbhw hed @ax)
Bypavamhnol`
Bnoarrbhcl`, Imuld
dnpmntlae, Le`rnhsndvhs`umhr `hph`lthe`n
@hrdlacnel`
Oyaphtbl`,On`bhel`hm, Hrrbytbol`
Dlstrljutlvn
Pnptl`, nt`.
Ajstru`tlvn
VN, pnrl`hrdltls,peuoatbarhx nt`.
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Bypavamnol` sba`gBypavamnol` sba`g ‐ Tbls ls tbn oast `aooae typn ai sba`g hed
jhsnd ae lesuiil`lnet `lr`umhtlec vamuon. Lts prlohry `husn ls mass ai imuld irao tbn
`lr`umhtlae irao nltbnr he letnrehm ar nxtnrehmsaur`n.
He letnrehm saur`n ohy jn bhnoarrbhcn. Nxtnrehm `husns ohy le`mudn nxtneslvn
jmnndlec, blcb autput ilstumhn ar snvnrnjures.
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<
@hrdlacnel` sba`g@hrdlacnel` sba`g ‐ Tbls typn ai sba`g ls `husnd jy tbn ihlmurn ai
tbn bnhrt ta puop niin`tlvnmy. Tbls `he jn dun ta dhohcn ta tbn bnhrt
ous`mn, oast aitne irao h mhrcn oya`hrdlhmleihr`tlae.
Atbnr `husns ai `hrdlacnel` sba`g le`mudn
hrrbytbolhs, `hrdlaoyaphtby, `aecnstlvnbnhrt ihlmurn (@BI), hed `hrdlh` vhmvnprajmnos.
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Dlstrljutlvn sba`g
Dlstrljutlvn sba`g ‐
Hs le bypavamnol` sba`g tbnrn ls he lesuiil`lnet
letrhvhs`umhr vamuon ai jmaad
Tbls iaro ai "rnmhtlvn" bypavamnolh ls tbn
rnsumt ai dlmhtlae ai jmaad vnssnms wbl`bdlolelsbns systnol` vhs`umhr rnslsthe`nNxhopmns ai tbls iaro ai sba`g hrn;
8. Pnptl` sba`g
:. Hehpbymh`tl` sba`g 0. Enuracnel` sba`g
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Ajstru`tlvn sba`g
Ajstru`tlvn sba`g ‐ Le tbls sltuhtlae tbn imaw ai jmaad ls ajstru`tnd
wbl`b lopndns `lr`umhtlae hed `he rnsumt le
`lr`umhtary hrrnst. Pnvnrhm `aedltlaes rnsumt le tbls iaro ai sba`g,
le`mudlec;8. @hrdlh` thopaehdn
:. Tneslae penuoatbarhx 0. pumoaehry nojamlso 4. Hartl` stneasls
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8:
Neda`rlen sba`gZn`netmy h ilitb iaro ai sba`g bhs jnne letradu`nd;jhsnd ae neda`rlen dlsturjhe`ns.
@husns; Bypatbyraldlso, le `rltl`hmmy lmm phtlnets, rndu`ns `hrdlh` autput
hed `he mnhd ta bypatneslae hed rnsplrhtary lesuiil`lne`y
Tbyrataxl`asls ohy ledu`n h rnvnrsljmn `hrdlaoyaphtby
H`utn hdrnehm lesuiil`lne`y ls irnqunetmy tbn rnsumt aidls`aetleulec `artl`astnrald trnhtonet wltbaut thpnrlec tbndashcn
Bawnvnr, surcnry hed letnr`urrnet dlsnhsn le phtlnets ae`artl`astnrald tbnrhpy wltbaut hdkustlec tbn dashcn ta
h``aooadhtn iar le`rnhsnd rnqulrnonets ohy hmsa rnsumt le tbls`aedltlae
Znmhtlvn hdrnehm lesuiil`lne`y le `rltl`hmmy lmm phtlnets wbnrnprnsnet baroaen mnvnms hrn lesuiil`lnet ta onnt tbn blcbnrdnoheds
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@aophrlsae ai typns ai sba`g(Nhrmy sthcn)
Yhsa`aestrl`tlvn Yhsadlmhthtlvn
Bypavamhol` @hrdlacnel` @lr`umhtary Pnptl`
@hrdlh`
lednx
@hrdlh`lednx
Vnrlpbnrhmrnslsthe`n
Vnrlpbnrhm
rnslsthe`n
JmaadYamuon Jmaad Yamuon
Ohmpnriuslae hed arche dysiue`tlae hrn tbn umtlohtn ned palet ai hey sba`g sthcn
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Dn`rnhsnd `hrdlh` autput
Dn`rnhsnd jmaad prnssurn
Dn`rnhsnd tlssun pnriuslae
Dn`rnhsnd `araehry pnriuslae
Dn`rnhsnd oya`hrdlhm iue`tlae
Ol`ra`lr`umhtary
ajstru`tlae
@nmmumhr hccrnchtlae
Ol`ra`lr`umhtary dnohcn
@nmm bypaxlh
Onthjaml`
h`ldasls
Dn`rnhsnd
oya`hrdlhm
`aetrh`tlae
Lerh`nmmumhrimuld
mass
Dn`rnhsnd
vneaus rnture
JV ? @A x PYZ
Vhtbapbyslamacy @ae`npt Ohp
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8>
Bypavamnol` Pba`g
mass le `lr`umhtary vamuon
Dn`rnhsnd vneaus rnture
Dn`rnhsnd ilmmlec ai tbn `hrdlh` `bhojnrs
Dn`rnhsnd `hrdlh` autput
le`rnhsn le tbn systnol` vhs`umhr rnslsthe`n (PYZ).
maw `netrhm vneaus prnssurn (@YV), h maw pumoaehry `hplmmhry wndcn prnssurn (V@SV), maw
`hrdlh` autput (@A) hed `hrdlh` lednx (@L), hed blcb PYZ. Tbn hrtnrlhm jmaad prnssurn ohy jn
earohm ar maw.
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B\VAYAMNOL@ (amlcnol`)PBA@G
Bnoarrbhcl`
- Trhuoh
- Chstraletnstlehm
- Zntrapnrltaenhm
• Imuld dnpmntlae (eaebnoarrbhcl`)
Nxtnrehm imuld mass
Dnbydrhtlae
Yaoltlec
Dlhrrbnh
Vamyurlh
Letnrstltlhm imuld rndlstrljutlae
Tbnrohm lekury
Trhuoh
Hehpbymhxls
• Le`rnhsnd vhs`umhr`hph`lthe`n (vneadlmhthtlae)
- Pnpsls
- Hehpbymhxls
- Taxles/Drucs
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@hrdlacnel` Pba`g
dnpnednet ae paar puop iue`tlae
h`utn `hthstrapbl` ihlmurn ai mnitvnetrl`umhr puop iue`tlae
blcb V@SV, maw @A hed @L, hed cnenrhmmy h blcb PYZ
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82
@HZDLACNEL@
Oyaphtbl`
-Oya`hrdlhm leihr`tlae (Mnit
vnetrl`mn, Zlcbt vnetrl`mn)
-Oya`hrdlhm `aetuslae(trhuoh)
-Oya`hrdltls
-@hrdlaoyaphtby
-Vast ls`bnol`
oya`hrdlhm stueelec
-Pnptl` oya`hrdlhmdnprnsslae
-Vbhroh`amacl` Hetbrh`y`mlen`hrdlataxl`lty @hm`luo`bheenm jma`gnrs
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8<
On`bhel`hm
-Yhmvumhr ihlmurn Zncurclthet Ajstru`tlvn
-Bypnrtrapl` `hrdlaoyaphtby
-Ynetrl`umhr snpthm dnin`t
Hrrbytbol`
-Jrhdy`hrdlh Pleus (n.c.,vhchmsye`apn)Htrlavnetrl`umhr jma`gs
-Th`by`hrdlh Puprhvnetrl`umhrYnetrl`umhr
@HZDLACNEL@ (:)
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:6
DLPTZLJ^TLYN
Pnptl` (jh`tnrlhm, iuechm, vlrhm, rl`gnttslhm)
Taxl` sba`g syedraon
Hehpbymh`tl`, hehpbymh`tald
Enuracnel` (splehm sba`g)
Neda`rleamacl`
Hdrnehm `rlsls
Taxl` (n.c., eltraprussldn, jrntymmluo)
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:8
Nxtrh`hrdlh` ajstru`tlvn sba`g Lophlrnd dlhstaml` ilmmlec (dn`rnhsnd
vnetrl`umhr prnmahd) h pbysl`hm lophlronet ta hdnquhtn iarwhrd `lr`umhtary imaw levamvlec
on`bhelsos (dliinrnet tbhe prlohry oya`hrdlhm ar vhmvumhr dysiue`tlae )
Irheg dn`rnhsn le ilmmlec prnssurns (hs le ondlhstlehm `aoprnsslaes ai
crnht vnles) ar
trneds tawhrds nquhmlzhtlae ai prnssurns le tbn `hsn ai `hrdlh`thopaehdn ar
ohrgndmy le`rnhsnd rlcbt vnetrl`umhr ilmmlec prnssurns
Blcb @YV, maw V@SV @hrdlh` autput ls usuhmmy dn`rnhsnd wltb le`rnhsnd PYZ.
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::
Pyoptaos
Ehrrawlec aipumsn prnssurn
Th`by`hrdlh,bypatneslae
Znstmnssens
Dlspbarlh
Dn`rnhsnd urlenautput
Hexlnty @aam, `mhooy sgle
Ajtuedhtlae
Dyspenh ^e`aes`lausenss
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:0
Trnhtonet aisba`g
Cnenrhmltlns;
Vasltlaelec, hvaldlec
bypatbnrolh Ohlethlelec hdnquhtn
axycnelzhtlae
Imuld rnsus`lthtlae
Vhle rnmlni 1
(leatrapl` trnhtonet1)
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:4
Nebhe`n `aopneshtary pbhsnai tbn sba`g
Ohletnehe`n ai onhe `lr`umhtary prnssurn
Ohxlolzlec `hrdlh` iue`tlae
Zndlstrljutlec pnriuslae ta vlthm arches
Aptlolzlec uemahdlec ai axycne ht tlssuns
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:>
Ohlethle Yamuon
-Imuld rndlstrljutlae tavhs`umhr sph`n
Irao letnrstltluo(Pthrmlec niin`t)
Irao letrh`nmmumhrsph`n (Asoatl`niin`t)
-Dn`rnhsnd rnehm imuldmassns
Dn`rnhsndcmaonrumhr ilmtrhtlaerhtn (CIZ) Le`rnhsndhmdastnraen
Le`rnhsndvhsaprnssle
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:9
Olethle Vrnssurn
Dn`rnhsnd vneaus `hph`lthe`n
Le`rnhsnd syophtbntl` h`tlvlty
Le`rnhsnd `lr`umhtlec (hdrnehm) nplenpbrlen
Le`rnhsnd heclatnesle
Le`rnhsnd vhsaprnssle
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:3
Ohxlolzn @hrdlh` Vnriarohe`n
Le`rnhsnd `aetrh`tlmlty
Pyophtbntl` stloumhtlae Hdrnehm stloumhtlae
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:2
Nhrmy on`bhel`hm vnetlmhtlae
hmmaws jmaad imaw ta jn rndlstrljutnd
tneds ta rnvnrsn mh`tl` h`ldasls
supparts tbn phtlnet uetlm atbnr
tbnrhpnutl` onhsurns `he jn niin`tlvnTldhm vamuons le tbn ardnr ai 3-86 omgc-8 ai mnhe jady ohss, he A:
`ae`netrhtlae tbht rnsumts le hrtnrlhm shturhtlae eat mnss tbhe <:%, hdnquhtn
vnetlmhtar rhtn hed sndhtlae ta olelolzn tbn warg ai jrnhtblec.
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:<
Imuld rnsus`lthtlae
LY mlen
Mhrcn jarn `heeumh
Oarn lv mlen
@bal`n ai leiuslae
Mh`thtnd Zlecnr's
samutlae (leltlhmjamus; 86-:> om/gc / 86 ole.)
@ammalds
Dnxtrhen
Bydrantbymstrh`b Cnmhtlen
Pohmm vamuon rnsus`lthtlae
Zhtn, hoauet
Cnenrhm `aedltlaes
phrhontnrs ( JV, Vumsn,@YV, PhtA
: nt`)
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06
Dnxtrhen
Oamn`umhr wnlcbt; 46G - 96/36G Dhmtae
@ae`netrhtlae; 86% (46G)*7 9% (96/36G)**
Shtnr jledlec; :> om/c -- 4 - 9 b
Vmhsoh nxphedlec niin`t; * 826-:667 ** 8>6%
Nmlolehtlae;
onthjaml`
gldeny
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Bydraxyntbymstrh`b
Oamn`umhr wnlcbt; 4>6G - :66G - 46G Dhmtae
Pujstltutlae; 6,> - 6,9: - 6,3
Shtnr jledlec; 8> - :6 om/c -- 0 - 9 b
9% BNP (:66G/6,>) -- pmhsoh sujstltutlae (866%)
86%BNP (:66G/6,>) -- pmhsoh nxphedlec (846%)
Nmlolehtlae;
gldeny
8: - :4 b (9> - 36 %) --- 892 b
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0:
Leatrapl` drucs
Leatrapln Bnhrt rhtn PYZ Gldeny
Jmaad imaw
@arehrry
Jmaad imaw
@hrdlh`
Autput
Dasn
Nplenpbrle ++ + + - + + 86-06
o`c/ole
Earnplenpbrle ++ 6 ++ -- + + :-2o`c/ole
Daphole ++ + - ++ + ++ :->o`c/ole/gc
Dajuthole +++ (+) -- + + ++ >-8>o`c/ole/gc
Lsapratnrneam ++ ++ - + + ++ > o`c/ol
Horleae +++ 6 -- + + ++
Jamus 6.> -8.> oc/gc
@aet.; : ta
86o`c/gc/ole
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00
Iurtbnr Ptudy;
Kayet, Chvle (Hprlm :660). "Letradu`tlae taohehcnonet ai sba`g iar kuelar L@^ trhlenns hedondl`hm studnets". Tbn @blensn ^elvnrslty ai
Baec Gaec. Zntrlnvnd ae < A`tajnr, :684.