shock
DESCRIPTION
SHOCK. Dr Begashaw M (MD). Introduction. i s a life-threatening condition occurs when the circulatory system fails to deliver oxygen and nutrients to the body tissues & becomes unable to remove waste products - PowerPoint PPT PresentationTRANSCRIPT
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SHOCK
Dr Begashaw M (MD)
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Introduction
• is a life-threatening condition• occurs when the circulatory system fails to
deliver oxygen and nutrients to the body tissues & becomes unable to remove waste products
• may rapidly progress to an irreversible state with subsequent multi-organ failure and death
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DEFINITION
• a pathological state causing inadequate oxygen delivery to the peripheral tissues and resulting in lactic acidosis, cellular hypoxia & disruption of normal metabolic condition
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CLASSIFICATION
1. Hypovolemic 2. Cardiogenic 3. Obstructive4. Distributive - Septic shock - Neurogenic shock - Anaphylactic shock
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Shock• Hypovolemic
– Hemorrhage– Anemia– Fluid loss
• Obstructive– Aortic valve stenosis
• Distributive– Sepsis– Thyrotoxicosis– Anaphylaxis
• Cardiogenic– Decompensated CHF– Acute coronary syndrome– Dysrhythmia – Myocarditis
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Cardiogenic•CHF•ACS•Dysrhythmia
Distributive•Sepsis•ThyrotoxicosisObstructive•Aortic valve stenosis
Hypovolemic•Hemorrhage•Anemia
Preload
Afterload
InotropyShock
MAP = (SV x HR) x SVR
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Preload
Afterload
Contractility
Arterialpressure
Cardiacoutput
Peripheralresistance
Heartrate
Strokevolume
Leftventricular
size
Myocardialfiber
shortening
Cardiac Performance
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Cardiovascular & metabolic characteristics of shock
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Hypovolemic shock
• inadequate vascular volume• results from loss of fluid from circulation, either
directly or indirectlyE.g▪ Hemorrhage• Loss of plasma due to burn• Loss of water & electrolytes in diarrhea• Third space loss
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Where do pt bleed enough to die?
• Remember, there are only 5 places into which a person can bleed enough to cause hemodynamic instability– Chest– Peritoneum– Retroperitoneum– Thighs– World
Not the mediastinum
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Cardiogenic shock
• impaired cardiac function• myocardial infarction • pericardial tamponade
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Obstructive Shock
• Resistance to cardiac outflow– ↑ afterload– Aortic stenosis– Tension pneumothorax
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Septic Shock (vasogenic shock)
• as a result of the systemic effect of infection• result of a septicemia with endotoxin and
exotoxin release by gram-negative and gram-positive bacteria
• impaired extraction as a result of impaired metabolism
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Neurogenic shock
• disruption of the sympathetic nervous system
- to pain - loss of sympathetic tone, as in spinal cord
injuries
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PATHOPHYSIOLOGY OF SHOCK
• stimulates a physiologic response - conserve perfusion to the vital organs (heart
and brain) - vasoconstriction of skin, splanchnic & renal
vessels leads to renal cortical necrosis and acute renal failure
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Hypovolemic shock: physiology
• Reduced blood volume• Reduced preload• Reduced stroke volume• Reduced cardiac output Response to shock - physiology
– Cathecholamines , ADH– Vasoconstriction, tachycardia– Improve venous return and CO
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CLINICAL FEATURES
• Tachycardia• Feeble pulse• Narrow pulse pressure• Cold extremities (except septic shock)• Sweating, anxiety• Breathlessness / Hyperventilation• Confusion leading to unconscious state
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ClassParameter I II III IV
Blood loss (ml) <750 750–15001500–2000 >2000
Blood loss (%) <15% 15–30% 30–40% >40%Pulse rate (beats/min) <100 >100 >120 >140
Blood pressure Normal Decreased Decreased Decreased
Respiratory rate (breaths/min) 14–20 20–30 30–40 >35
Urine output (ml/hour) >30 20–30 5–15 Negligible
Mental status Normal Anxious Confused Lethargic
Classification of Hemorrhage
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MANAGEMENT OF SHOCK
• restoring oxygen delivery to the cells of vital organs
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General Management
Priority-ABC• Stop bleeding• Fluid resuscitation-crystalloids• Head down position-flat • Transfusion• Oxygen , inotropic • Monitoring -determine hourly urine output, BP,
pulse rate
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Specific Management
Hypovolemic Shock• Restore vascular volume• Fluid and blood replacement• Oxygen support
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Specific Management
Septic Shock• antibiotics• Inotropic –adrenaline,dopamine• Surgical eradication of the infection focusCardiogenic shock• InotropesNeurogenic shock• Pain relief• Treat the causes, give supportive measures - inotropic support
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COMPLICATIONS OF SHOCK
1. Shock lung (ARDS)2. Acute renal failure3. Gastrointestinal ulceration4. Disseminated intravascular coagulation5. Multiorgan failure6. Death
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Questions?