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    1. SHOCK

    2. Objectives Understand what shock is Define types of shock Understand Pathophysiology of shock Understand how to treat shock

    3. WHAT IS SHOCK? Inadequate Tissue Perfusion

    4. Symptoms of Shock Anxiety /Nervousness Dizziness Weakness Faintness Nausea & Vomiting Thirst Confusion Decreased UO Hx of Trauma / other illness Vomiting & Diarrhoea Chest Pain Fevers / Rigors SOB

    5. Signs of Shock Pale

    6. Circulatory Homeostasis BP = CO X PVR

    7. Cardiac Output CO = SV X HR This means that BP= SV X HR X PVR Blood Pressure = Stroke Volume X Heart Rate X Peripheral Vascular Resistance

    8. Stroke Volume Volume of Blood pumped by the heart during 1 cycle

    9. What makes up blood volume

    10. What Alters Blood Volume? Haemorrhage Plasma Loss Redistribution of Extracellular Volume

    11. Heart Rate Heart rate increases as a compensatory response to Shock Rarely you get High Output failure Heart rate too fast to allow adequate refilling of heart between beats

    12. Peripheral Vascular Resistance PVR regulated by ARTERIOLAR tone. Dilatation opens Arteriovenous beds & increases volume of circulatory system

    13. What Alters PVR? Circulation cytokines & Inflammatory mediators (e.g. Histamine) Endotoxins Drugs (e.g. Nitrates)

    15. Types of Shock Hypovolaemic Cardiogenic Redistributive

    16. Hypovolaemic Volume Loss Blood loss -Haemorrhage Plasma Loss -Burns / Pancreatitis ECF Loss - V&D

    17. Cardiogenic Pump Failure May be due to inability of heart to Contact Inability of heart to pump blood

    18. Redistributive Decreased Peripheral Vascular Resistance Septic Shock Spinal / Neurogenic Shock ANAPHYLACTIC shock

    19. Pathophysiological Response Flight or fight response Increased Catecholamine release Activation of Renin-Angiotensin system Increase glucocorticoid and mineralcorticoid release Activation of Sympathetic nervous system

    20. Treatment of Shock ABC

    21. Treatment of Shock Ensure Adequate Intravascular Volume Support Pump

    22. Anaphylactic Shock Caused by a hypersensitivity reaction to an allergen in a previously sensitised patient

    23. Common Allergens Nuts Bee / Wasp Stings DRUGS

    24. Common Features Angio-oedema Bronchoconstriction Vasodilatation and hypotension Urticareal rash

    25. Angio-oedema


    27. Treatment Ensure Airway is adequate Oxygen IV access early IV fluids ADRENALINE 0.5ml 1 in 1000 IM Bronchodilators Steroids

    28. SHOCK Clinical Scenarios

    29. 1) A 26 year old man with a comminuted closed fracture of the femur shaft undergoes intramedullary nail fixation. Two days post operatively, he develops a pyrexia, shortness of breath and tachycardia. Discuss the emergency management?

    30. 2) A 72 year old man develops sudden back pain and is brought to the emergency department with a swollen ,tense abdomen. He is tachycardic ,with a low volume pulse and low BP. Discuss the emergency management?

    31. 3) A 72 year old man with an underlying prostate carcinoma sustains a femoral shaft fracture .He undergoes intramedullary nail fixation. At post operative day 7 he develops a shortness of breath ,hypotension and a tachycardia Discuss the emergency management?