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In the name of GOD
Hypotention/shock
Reza ghaderi DR
1393-spring
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DefinitionShock is a physiologic state
characterized by a significant reduction of systemic tissue perfusion, resulting in decreased oxygen delivery to the tissues.
This creates an imbalance between oxygen delivery and axygen consumption.
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Tissue perfusion = cardiac out put * sys vascular resistance
C.O = heart rate * stroke volume
Stroke volume depend on preload, afterload, myocardial contractility
S.V.R depend on vascular length , vascular diameter , after load
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Type of shock;
HypovolemicCardiogenicDistributive
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Hypovolemic; decreased preload due to intravascular volume loss that resulting decreased cardiac output and P.C.W.P and increased S.V.R.ni
Cardiogenic; decreased cardiac contractility; pump failure; decreased C.O and increased S.V.R and P.C.W.P
Distributive; consequence of severely decreased S.V.R.
C.O increased for compensation and P.C.W.P may nl or low
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Shock stages;Pre shock; reduction of 10% intra vascular
volumeWarmness, increased heart rate, peripheral
vasoconstriction
Shock; reduction of 25% intra vascular volume
Tachycardia, tachypnea, agitation, met acidosis, oligouria, sweating, cold skin
End organ damage; decreased C.O
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Clinical manifestation
Hypotention ;that present in all type of shockSys BP<90 or more than 40mmHg reduction in base
Decrease level of conciseness ; agitation to coma
Oliguria; due to blood shifting toward principal organsCool and clammy skin; due to blood shifting to vital
organsMetabolic acidosis; due to decreased clearance of
lactate in liver, kidney , skeletal muscle.
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Associated finding;Hematemesis, hematochesia , melena ,
vomiting , diarrhea , abd pain , trauma , post operation state
P/E;Dry skinDry axilla
Decreased skin turgorDecreased HbDecreased J.V.P
Increased amylase and lipase
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Cardiogenic shock; chest pain, dyspnea , palpitation , C.V.D Hx, crackle , mur mur , gallop, increased JVP, ECG, cardiac marker ,
Distributive shock; dysuria, productive cough, dyspnea, hematuria, rash, fatigue, pain, tachypnea, tachycardia, increased W.B.C, photophobia
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DDX;Hypovolemic shock categorized to two group
Hemorhagic shock: trauma, gi bleeding, rupture of hematoma, hemorrhagic pancratitis, FX , rupture of aneurism ,
Loss of volume; diarrhea, vomiting, heat, burn, small intestine obstruction, pancratitis, cirrhosis ,
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Cardiogenic shock categorized to four groups;Myopathic; dilated cardiomyopathy, MI>40% LV
surface, RVMi , multi vessel diseaseArrhythmia ; AF, Flutter, V.T, bradyarrhythmia , C.H.B
Mechanical; valvular , mixom, V.S.DObstructive; extra cardiac; P.T.E, C.P, tamponad,
severe PAP
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Distributive;Septic shock, T.S.S, SIRS, anaphylaxis , drugs,
toxin, bites, transfusion, adrenal crisis, post CPR
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Approach;HXP/E
LabsMortality; 35-60% in septic shock
60-90% in cardiogenic shock variable in hypovolemic shock
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Management; Hypovolemic; rate of resuscitation
choice of fluid
Cardiogenic
distributive
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Good luck