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shock

shock. Definition. Hypotension. “ Hypoperfusion can be present in the absence of significant hypotension.”. Pathophysiology. ATP production Na-K pump Anaerobic metabolism acidosis. Physiological Response. Clinical picture. Signs of Organ Hypoperfusion

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shock

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  1. shock

  2. Definition

  3. Hypotension “Hypoperfusion can be present in the absence of significant hypotension.”

  4. Pathophysiology ATP production Na-K pump Anaerobic metabolism acidosis

  5. Physiological Response

  6. Clinical picture Signs of Organ Hypoperfusion Multiorgan Dysfunction Syndrome (MODS) Result is end organ failure

  7. Goals of Shock Resuscitation - Approach - Monitoring

  8. Airway

  9. Control Work of Breathing

  10. Optimizing Circulation -Crystalloids vs Colloids

  11. End Points of Resuscitation“Goal-directed therapy” Use objective hemodynamic and physiologic values to guide therapy Urine output > 0.5 mL/kg/hr CVP 8-12 mmHg MAP 65 to 90 mmHg Central venous oxygen concentration > 70%

  12. In general, treat the cause...

  13. Categories

  14. Hypovolemic Shock -Causes: Non-hemorrhagic Hemorrhagic -Signs

  15. Classes of Hypovolemic Shock

  16. Cardiogenic Shock -Causes -Signs

  17. Coronary PP = DBP - PAOP GOAL - Coronary PP > 50 mm Hg

  18. AMI • Aspirin, beta blocker, morphine, heparin • If no pulmonary edema, IV fluid challenge • If pulmonary edema • Dobutamine • Dopamine – will ↑ HR and thus cardiac work • PCI or thrombolytics • RV infarct • Fluids and Dobutamine (no NTG) • Acute mitral regurgitation • Pressors (Dobutamine and Nitroprusside) If inotropes and vasopressors fail, intra-aortic balloon pump

  19. Distributive Shock -Types : -Signs :

  20. Sepsis • Two or more of SIRS criteria • Temp > 38 or < 36 C • HR > 90 • RR > 20 • WBC > 12,000 or < 4,000 Plus • presumed existence of infection

  21. Treatment

  22. Septic Shock Sepsis Plus refractory hypotension After bolus of 20-40 mL/Kg.

  23. -Consider Vasopressors-Consider adrenal insufficiency

  24. Vasopressors • Assure adequate fluid volume • Administer via central venous line • Do not use dopamine for renal protection • Requires arterial line placement • Vasopressin: • Refractory shock

  25. Anaphylaxis IgE Mediated Hypersensitivity (type 1) -causes: -Anaphylactoid reaction:

  26. Signs • Biphasic phenomenon occurs in up to 20% of patients : Symptoms return 3-4 hours after initial reaction has cleared • Symptoms usually begin within 60 minutes of exposure • Faster the onset of symptoms = more severe reaction • A “lump in my throat” and “hoarseness” heralds life-threatening laryngeal edema

  27. Treatment • ABC’s • IVFs, oxygen • Epinephrine • Bronchodilators Magnesium sulfate • Second line • Corticosteriods • H1 and H2 blockers

  28. Neurogenic shock -Occurs after acute spinal cord injury -Any injury above T1 can disrupt the entire sympathetic system -usually lasts from 1 to 3 weeks

  29. Treatment A,B,Cs Fluid resuscitation Vasopressors Treat bradycardia Methylprednisolone

  30. Adrenal Crisis Causes Autoimmune adrenalitis Adrenal apoplexy = hemorrhage or infarct

  31. Treatment

  32. Obstructive Shock -Causes -Signs

  33. Summary Type PAOP C.O. SVR HYPOVOLEMIC  CARDIOGENIC  DISTRIBUTIVE  or N varies  OBSTRUCTIVE   

  34. The End

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