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Shock

Shock. Amr Mohsen. What is shock?. Acute circulatory failure leading to Inadequate tissue perfusion that results in Generalized organ hypoxia. 3 components. cardiovascular physiologic reserve. 1. Heart Rate

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Shock

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  1. Shock Amr Mohsen

  2. What is shock? Acute circulatory failure leading to Inadequate tissue perfusion that results in Generalized organ hypoxia

  3. 3 components

  4. cardiovascular physiologic reserve 1. Heart Rate 2. Stroke Volume [venous return (blood volume) & myocardial contractility & peripheral resistance] 3. Peripheral Resistance All exist in dynamic equilibrium. These interactions maintain blood pressure. If one of the three becomes abnormal, the other two compensate.

  5. Compensatory mechanisms

  6. Compensatory mechanisms

  7. Compensatory mechanisms

  8. Compensatory mechanisms Sympatho-adrenal Response

  9. Hypotension is an indication of: • An abnormality of Heart Rate, Stroke Volume or Peripheral Resistance • Failure of the others to compensate.

  10. Classification of shock failure loss =hypovolemia maldistribution

  11. Classification of shock • Hypovolemic shock blood loss, plasma loss (burns), fluid loss • Cardiogenic shock (pump failure) Arrhythmias, MI, tamponade • Maldistribution shock • Septic shock • Spinal shock • Anaphylactic shock

  12. Pathophysiology

  13. ARDS • Impaired ventilation • Stiff lungs (surfactant def.) • Alveolar oedema • Impaired perfusion • Shock • Shunts • Impaired diffusion • Oedema of alveolo-capillary membrane

  14. ARDS ARDS Late finding Normal Chest X-ray

  15. DIC

  16. DIC • Low platelet count • Low fibrinogen • Prolonged PT & APTT • Elevated Fibrin-degradation product Serious sign

  17. Management of Shock & MOF In ICU

  18. Treat Cause • Examples • Control bleeding • Eradicate sepsis (pus drainage) • Antibiotics

  19. Clinical parameters Pulse Temp (peripheral & core) Blood pressure Respiratory rate Monitoring • Continuous • ECG • Pulse oxymetry

  20. Urine output Optimum output 0.5-1ml/kg/hour. Monitoring

  21. (1) Arterial cannula for ABP Monitoring (invasive) (2) CVP N= 0-8 cmH2O (3) Swan Ganz (PAWP)

  22. Monitoring • Laboratory tests • CBC • Renal function tests (Urea & elect) • Arterial Bl Gases (ABGs) • Lactates • Liver function tests • PT, PTT & FDP

  23. Normal Arterial Bl Gases (ABGs) Monitoring Normal serum electrolytes

  24. Respiration Support Body Systems • Clear airway • - Suction of secretions • - Tracheal intubation or tracheostomy • Oxygen(essential) • - Mask for respiratory distress • - Mechanical ventilation for respiratory failure • PO2 < 60mm Hg RR > 35/m

  25. Support Body Systems Correct acidosis Careful use of IV sodium bicarbonate

  26. Circulation Support Body Systems • Correction of hypovolaemia(essential) • Two peripheral venous lines • One central venous line • Crystalloids • Blood • Plasma • Medications (if the above fail to restore BP) • Inotropes (e.g., dopamine & dobutamine) • Vasopressors (noradrenaline)

  27. Renal Support Body Systems • Adequate volume replacement • Dopamine improves renal blood flow • Dialysis in case of acute renal failure (K+ >7mmol/L), until the kidneys recover

  28. GIT Support Body Systems Routine acid suppression IV H2 blockers or Omeprazole

  29. Coagulation Support Body Systems • Treatment of DIC • Platelet transfusion • Fresh Frozen Plasma (FFP) as it contains coagulation factors

  30. Mortality of MOF • Renal failure only 8% • Renal + other organ failure 70% • Three failing organs 90%

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