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Shock

Shock. Tom Munford CT2 Anaesthesia Nottingham City Hospital. Outline. What is shock? Types of shock Treatment. What is shock?.

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Shock

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  1. Shock Tom Munford CT2 Anaesthesia Nottingham City Hospital

  2. Outline • What is shock? • Types of shock • Treatment

  3. What is shock? ‘Clinical syndrome in which the circulation is unable to deliver adequate end organ perfusion resulting in cellular hypoxia and eventually irreversible cellular injury’

  4. Components of the Circulatory system PUMP PIPES FLUID ORGANS

  5. How do I know my patient is shocked? • Look unwell • Tachycardic • May be hypotensive • Signs of inadequate organ perfusion- low UO- raised lactate- confusion

  6. How do I treat shock? • A-E assessment • Treat as you find • Large bore IV access • Fluid resuscitation • Search for cause and specific treatment

  7. Types of shock Hypovolaemic Distributive Obstructive Cardiogenic

  8. Hypovolaemic • Commonest type • Insufficient circulatory volume • Bleeding, vomiting, burns, dehydration • Resuscitate with IV fluid • Treat underlying cause (e.g.: surgery if bleeding)

  9. Classification of Hypovolaemic Shock

  10. Distributive • Neurogenic- trauma- failure of sympathetic nervous system to maintain vascular tone • Septic- history suggestive of infection- raised temperature

  11. Sepsis 6 • High flow oxygen • Take blood cultures • Broad spectrum IV antibiotics • IV fluid resuscitation • Measure Hb and Lactate • Monitor hourly urine output

  12. Obstructive • Prevention of blood flow from the heart • Cardiac tamponade, tension pneumothorax, massive PE • Signs- dilated neck veins- muffled heart sounds- unilaterally decreased breath sounds- deviated trachea

  13. Needle Decompression

  14. Pericardiocentesis

  15. Cardiogenic • Commonly seen post MI • Signs- history suggestive- dilated neck veins- pulmonary oedema • Caution with fluids • Inotropes (e.g.: dopamine, dobutamine)

  16. Summary • Shock is common • Shock can be life threatening • Can be treated by doing the basics well • Four main types- Hypovolaemic- Distributive- Obstructive- Cardiogenic

  17. Questions?

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