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Christie Holt, 14yrs old.. Went to see her GP  Flu-like symptoms,sore throat,head ache.

Christie Holt, 14yrs old.. Went to see her GP  Flu-like symptoms,sore throat,head ache. But shortly after being sent home she developed a rash and her family dialled 999 for an ambulance.  Miss Holt was admitted at 7.15am and died 14 hours later . Septic shock. Shocked???. Drugs for Shock.

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Christie Holt, 14yrs old.. Went to see her GP  Flu-like symptoms,sore throat,head ache.

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  1. Christie Holt, 14yrs old.. • Went to see her GP Flu-like symptoms,sore throat,head ache. • But shortly after being sent home she developed a rash and her family dialled 999 for an ambulance. •  Miss Holt was admitted at 7.15am and died 14 hours later . • Septic shock

  2. Shocked???

  3. Drugs for Shock

  4. Shock • Condition in which vital tissue and organs are not receiving enough blood to function properly • Without adequate oxygen and other nutrients, cells cannot carry out the normal metabolic processes. • Medical Emergency • Failure to reverse the causes and symptoms may lead to irreversible organ damage and death

  5. Signs and Symptoms • Many are nonspecific • Pale • “feel sick”, weak with no specific complaint • Behavioral changes • Pain • Thirsty • Cold or clammy • Without immediate treatment, multiple body systems will be affected and respiratory or renal failure may result.

  6. Shock • Central problem in most types of shock is the inability of the cardiovascular system to send sufficient blood to vital organs, with the heart and brain being affected early in the progression of the disease • Blood pressure • Cardiac output diminished • Heart rate , rapid weak thready pulse • Respiratory Rate ,rapid and shallow

  7. Types of Shock • Hypovolemic shock • Neurogenic shock • Cardiogenic shock • Septic shock • Anaphylactic shock

  8. Hypovolaemic Shock • Low Volume • Causes: haemorrhage burns vomiting diuresis sweating diarrhoea Cardiogenic Shock • Pump Failure • Causes: acute MI CHF obstruction arrhythmias

  9. Neurogenic Shock • Loss of tone of blood vessels • Causes: spinal cord damage, anaesthesia, hypoglycaemia • Mass release of histamine due to allergic hypersensitivity reaction (foods, insect bites, blood transfusion, drugs) • Increased capillary permeability with vasodilatation reduces venous return and BP Anaphylactic

  10. Septic • Systemic infection • Bacterial toxins • Associated with pyrexia, marked generalised vasodilatation and intravascular micro-clotting • Immunocompromised patients at risk

  11. Treatment Priorities for Shock • ABC’s of life support • Airway • Breathing • Circulation • Identify underlying cause; then start more specific treatment • Keep client warm and quiet • Offer psychological support

  12. Hypovolemic Shock • Restore blood volume by suitable fluids IV • Administer electrolytes & oxygen • Morphine IV • Dopamine IV

  13. Cardiogenic shock • Elevate the limbs • Nitroglycerine SC • Morphine / Pethidine IV • Oxygen • Aspirin – oral • Dopamine IV

  14. Type I allergic reaction( Anaphylactic reaction) drug ( antigen) ↓ antibody ( IgE) ↓ attached to mast cells ↓ AG:AB reaction ↓ release of mediators( histamine,LTs) ↓ Penicillin Streptokinase heparin Second exposure Urticaria Itching Angioedema Asthma hypotension

  15. Anaphylaxis Treatment • Put the patient in reclining position • Administer Oxygen • Inject Adrenaline 0.5mg IM • Administer Chlorpheniramine 10-20mg IM • Inject Hydrocortisone 100-200 mg IV

  16. Drugs for Shock – Fluid Replacement • Blood or blood products • May be administered to restore fluid volume • Whole blood for acute, massive blood loss (more than 30% of total volume) • Replace plasma volume and supply red blood cells • Components • Whole blood, plasma protein fraction • Fresh-frozen plasma, packed red blood cells

  17. Whole Blood • Indicated for treatment of acute, massive blood loss • 30% or more of total volume • Supply depends on donor • Requires careful cross-matching • Can transmit infections such as hepatitis or HIV

  18. Colloids • Expand plasma volume and maintain blood pressure • Used when up to one-third of adult client’s blood volume lost • Stay suspended in blood • Draw molecules from body’s cells and tissues into blood vessels • Oncotic pressure • Examples: normal human serum albumin, plasma protein fraction, dextran, hetastarch

  19. Colloid Agents • Mechanism of action: to maintain plasma osmotic pressure; transport substances through blood • Primary use: restoration of plasma volume and blood proteins • Examples of blood colloids: normal human serum albumin, plasma protein fraction, serum globulins • Examples of nonblood-product colloids: dextan (40, 70, and high-molecular weight)and hetstarch (Hespan)

  20. Crystalloids • Intravenous solutions that contain electrolytes • Concentration resembling those of plasma • Mechanism of action: can readily leave blood and enter cells • Primary use: to replace fluids that have been lost and to promote urine output • Examples: normal saline, lactated Ringer’s, Plasmalyte, and hypertonic saline

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