Applied Sciences Lecture Course. Physiology of Shock. Mahesh Nirmalan MD, FRCA, PhD Consultant, Critical Care Medicine Manchester Royal Infirmary.
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Catastrophic deterioration of patients who are already in a hospital is frequently preceded by documented deterioration of physiological parameters
A clinical state in which the organs and tissues do not receive adequate blood flow to meet their metabolic needs.
Reperfusion, Surgery, Infection
Giannoudis PV. Injury, Int.J.Care Injured 2003;34;397-404
Fixed oxygen demand
Constant oxygen extraction
Venous oxygen saturation provides a good estimate of oxygen supply-demand balance in patients with shock
Slightly increased heart rate, local swelling, bleeding
Increased heart rate, increased diastolic blood pressure, prolonged capillary refill
Above findings plus: hypotension, confusion, acidosis, decreased urine output
Refractory hypotension, refractory acidosis, deathSigns of acute haemorrhagic shock
Blood pressure = CO * Vascular resistance
Hypovolaemic shock in an animal model of shock
Post ganglionic sympathetic fibres: Norepinephrine (A diffuse response)
Adrenals: Predominantly adrenaline
Reuptake : MAO
Local metabolism : Catechol-O-methyl-transferase
Systemic splilloverSympathetic response to trauma & shock
A nonspecific & generalized response to a variety of stressful stimuli
Increase in plasma osmolality by 20-30mOsmol
Mobilisation of extracellular fluid : upto 500ml
Jarhult J. Acta Physiol Scand 1973;89:213-226Hyperglycaemia in injury: an essential survival mechanism?
Corticosteroids, glucagon responses
Increased glycogenolysis & gluconeogenesis
Ischaemia-Reperfusion injuries in shock
BP= CO* SVR
Vasoplegia is a feature of ischaemia-reperfusion
Seek helpAvoid over reliance on invasive haemodynamic monitoring
Capillary fill time
Level of consciousness