SHOCK

SHOCK

1. Systemic reduction in tissue perfusion

   • O2 consumption and demand > O2 delivery
   • effects in different organs
     • HEART hypotension
     • LUNGS tachypnea and pulmonary edema
     • ENDOCRINE increases ADH (reabsorption of water)
     • CNS drowsy
     • BLOOD coagulation abnormalities
     • RENAL urine output decreases
     • GIT mucosal ischaemia, bleeding and hepatic failure

2. STAGES

   • INITIAL Cells switch to anaerobic metabolism
     • NON-PROGRESSIVE compensated
       • PROGRESSIVE decompensated
         • REFRACTORY organs fail and the shock can't be reversed

3. TYPES

   • Hypovolemic
     • blood loss
     • Plasma/body water loss
     • Electrolytes imbalance
   • Cardiogenic
     • Valvular heart disease
     • Myocardial infarction
     • Cardiac arrhythmias
     • Cardiomyopathy
   • Obstructive
     • Cardiac tamponade
     • pulmonary embolism
     • Tension Pneumothorax
     • Air embolism
   • Neurogenic
     • Paraplegia Quadriplegia
     • Trauma to spinal cord
     • Spinal anesthesia
   • anaphylactic
     • Injections
     • Anaesthetics
     • Stings
   • Septic
     • Bacterium (Gram + and Gram -)
     • Fungi
     • Virus
     • Protozoa

4. CLINICAL FEATURES

   • Depend on the degree of loss of volume and duration of shock
     • Mild shock
       • Pale and cold feet, sweat, thirst
     • Moderate shock
       • Drowsy and confused, oliguria, increased heart rate
     • Severe shock
       • Unconscious, gasping respiration, anuria, rapid pulse, profound hypotension

5. MANAGEMENT AND TREATMENT

   • MONITOR
     • Heart and respiratory rate
       • Urine output
         • Mead arterial pressure
           • Mental Status
   • PRINCIPLES OF RESUSCITATION
     • Airway
       • Breathing
         • Circulation
           • END POINTS OF RESUSCITATION
             • Urine output > 0.5 ml/kg/hr
               • CVP 8-12 mmHG
                 • MAP 65 to 90 mmHG
                   • ScvO2 > 70%
   • FLUID THERAPY
     • Crystalloid solutions
       • Colloid solutions
         • Blood tranfusion
           • Contributes to oxygen carrying capacity
   • OTHER TREATMENTS
     • Correction of acid-base balance
       • Steroids
         • Antibiotics (within an hour)
           • Catheterisation
             • Nasal O2 / ventilatory support
               • CVP line
                 • Control of pain
                   • ICU - critical care management