recognition of shock
TRANSCRIPT
1) Most common type of shock in children worldwide.
2) Body’s first action to maintain the Cardiac Output?
3) Common forms of Distributive Shock? 4) Causes of Obstructive Shock? 5) 3 factors that determine Stroke Volume?
THIS PART DISCUSSES THE FOLLOWING
Definition of shock
Pathophysiology of shock
Etilogy and signs of the 4 most common types of shock.
DEFINITION OF SHOCK
A critical condition that results from inadequate tissue delivery of O2 and nutrients to meet the tissue metabolic demands.
SHOCK CAN RESULT FROM
Inadequate blood volume or oxygen carrying capacity
Inappropriate distribution of blood volume and flow
Impaired cardiac contractility Obstructed blood flow.
COMPONENTS OF TISSUE OXYGEN DELIVERY
Adequate tissue O2 delivery depends onSufficient blood flow to the tissuesAppropriate distribution of blood flow to
the tissues.
STROKE VOLUME Amount of blood ejected by the heart with
each beat. Determined by 3 factors:
FACTOR CLINICAL DEFINITION
Preload Volume of blood present in the ventricle before contraction.
Contractility
Afterload Resistance against which the ventricle is ejecting
COMPENSATORY MECHANISMS
Tachycardia Increase in systemic vascular resistance Increase in strength of cardiac
contraction Increase in venous smooth muscle tone
EFFECT ON BPSystolic BP may initially remain
normal or even slightly elevated.
Pulse pressure is often narrrowed.
COMMON SIGNS Compensatory
MechanismArea Sign
Increased heart rate Heart Tachycardia
Increased SVR
SkinColdPaleMottleddiaphoretic
Peripheral Circulation
Delayed capillary refill
PulsesWeak peripheral pulsesnarrow pulse pressure
Increased renal and splanchnic
vascular resistance
Kidney Oliguria
Intestine Vomiting, ileus
1.HYPOVOLEMIC SHOCK
• Causes :• Diarrhea• Vomiting• Hemorrhage• Inadequate fluid intake• Osmotic diuresis• Large burns
Airway Typically patent Breathing Tachypnea
Circulation
TachycardiaWeak or absent peripheral pulsesDelayed capillary refillingOliguriaCold pale skin
HYPOVOLEMIC SHOCK
2.DISTRIBUTIVE SHOCK Abnormal distribution of blood flow in the small
blood vessels results in inadequate supply of blood to the body's tissues and organs
Most common forms of distributive shock are:SEPTIC SHOCKANAPHYLACTIC SHOCKNEUROGENIC SHOCK
SIGNS OF DISTRIBUTIVE SHOCK SEPTIC SHOCK:
Fever or hypothermia Altered WBC
ANAPHYLACTIC SHOCK: Anxiety or agitation Nausea & vomiting Urticaria Angioedema Hypotension Tachycardia
Airway Usually patent
Breathing Quiet tachypnea
Circulation
TachycardiaBounding peripheral pulsesBrisk or delayed capillary refillWarm and flushed skin ( Warm shock )Pale and mottled skin ( cold shock )
DISTRIBUTIVE SHOCK
3) CARDIOGENIC SHOCK Inadequate circulation of blood due to
primary failure of the ventricles of the heart to function effectively
Causes It can be due to damage to the heart muscle
Congenital heart disease Myocarditis Cardiomyopathy Arrhythmias Poisoning due to drug toxicity Myocardial Injury
CARDIOGENIC SHOCK
Airway Usually patent
BreathingTachypneaIncreased respiratory effort
Circulation
TachycardiaSigns of congestive cardiac failureCyanosisCold and pale skin
4.OBSTRUCTIVE SHOCK Shock associated with physical
obstruction of the great vessels or the heart itself.
CARDIAC TAMPONADE-Muffled heart soundsPulsus paradoxusDistended neck veins
TENSION PNEUMOTHORAX:Tracheal deviation towards contralateral
sideHyper resonant on affected sideDiminished breath sounds on affected side
OBSTRUCTIVE SHOCK
DUCT DEPENDED LESIONSHigher pre ductal vs post ductal
blood pressureAbsence of femoral pulsesMetabolic acidosis
OBSTRUCTIVE SHOCK