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Shock

Shock . WCS Teaching Evening. What is shock?. Acute failure of circulation resulting in impaired or absent perfusion to tissues and subsequent insufficient oxygen provision to cells. Five Main types. Hypovolaemic Cardiogenic Mechanical Septic Anaphylactic . Causes of Hypovolaemic shock.

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Shock

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  1. Shock WCS Teaching Evening

  2. What is shock? • Acute failure of circulation resulting in impaired or absent perfusion to tissues and subsequent insufficient oxygen provision to cells.

  3. Five Main types • Hypovolaemic • Cardiogenic • Mechanical • Septic • Anaphylactic

  4. Causes of Hypovolaemic shock • Obvious blood loss (external) • Internal blood loss, any major source of internal bleeding • MASSIVE vomiting and/or diarrhea

  5. Pathophysiology • BASICALLY: • Lost circulating volume, less blood goes into heart, less blood therefore gets pumped out of the heart, therefore BP drops. • END RESULT? Oxygen delivery impaired, cells are gradually doomed

  6. Signs and Symptoms • Cold pale clammy skin. Poor cap. Refill • Tachycardia • BP – early is increased, later on drops • Tachypnoea • Oligo/Anuria • Confusion, restlessness, anxiety, dizziness • Switch to Anaerobic metabolism, results in lactic acid production and acidosis

  7. Management • Oxygen, replace lost fluid • FIX UNDERLYING CAUSE

  8. Cardiogenic • Usually due to MI, heart can no longer pump blood • Backlog of blood builds up in lungs: • RV failure - JVP • Dyspnoea • Crackles/wheeze • Pulmonary oedema

  9. Diagnosis and Management • History, ECG, Trop T, angiography • Morphine, Oxygen, Nitrates, Aspirin • Thrombolysis • Fluids or diuretics?

  10. Mechanical Shock • Tension pneumothorax & Cardiac tamponade: prevent filling of heart • PE: Overloading of RV and hypovolaemia of LV • All present with features of shock, fix underlying cause

  11. Septic Shock • Infection of the blood results in systemic inflammatory response and mass vasodilation – fluids leaks out. • Tachycardia • Tachypnoea • Hypotension • Fever OR Hypothermia • WCC >12 or <4

  12. Septic Shock • Early on – warm (vasodilated peripheries), as condition progresses becomes cold. • Rigors are common.

  13. SEPSIS SIX • FBC • High flow oxygen • Fluid resus • Urine output • Blood culture & serum lactate • High dose empirical antibiotics • Administer if sepsis is SUSPECTED. Treat as septic until proven otherwise. • Multi organ failure and mortality rates are very high

  14. Anaphylactic Shock • IgE mediated – type I hypersensitivity • Allergen stimulates IgE to bind mast cells which then degranulate and release histamine. • Vasodilation and increased capillary permeability.

  15. Anaphylactic Shock • Acute, within 30 mins • Erythema, oedema • Tachycardia, hypotension • BRONCHOSPASM, OBSTRUCTIVE SWELLING • Vomiting & Diarrhoea • Adrenaline and oxygen. Fluids if needed, steroids and antihistamines for support.

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