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D. P. Laporta MD SMBD-JGH Dept of Adult Critical Care

D. P. Laporta MD SMBD-JGH Dept of Adult Critical Care. SHOCK - OUTLINE. DEFINITION CAUSES EFFECTS OF INEFFECTIVE TREATMENT ASSESSMENT CLINICAL APPROACH. CASE. CASE. CASE. CASE. CASE. CASE.

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D. P. Laporta MD SMBD-JGH Dept of Adult Critical Care

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  1. D. P. Laporta MD SMBD-JGH Dept of Adult Critical Care

  2. SHOCK - OUTLINE • DEFINITION • CAUSES • EFFECTS OF INEFFECTIVE TREATMENT • ASSESSMENT • CLINICAL APPROACH

  3. CASE

  4. CASE

  5. CASE

  6. CASE

  7. CASE

  8. CASE

  9. 1. post Cardiac Surgery - same day - 1 week postop2. in MVA victim3. In young male with Crohn ’s disease found febrile in shock4. In drug addict, hospital worker SHOCK CASES

  10. SHOCK - • DEFINITION • CAUSES • EFFECTS OF INEFFECTIVE TREATMENT • ASSESSMENT • CLINICAL APPROACH

  11. DEFINITION A profound disturbance of the circulation and metabolism, leading to inadequate perfusion of vital organs, necessary to maintain homeostasis

  12. SHOCK - • DEFINITION • CAUSES • EFFECTS OF INEFFECTIVE TREATMENT • ASSESSMENT • CLINICAL APPROACH

  13. HYPOPERFUSED STATES RV LV PVR Venous (capacitance) Arterial (resistance) EF End-Diastolic Volume SVR

  14. BP 60/30 HR 140/min CVP 0 Lactate 10 Hypovolemic

  15. BP 70/50 HR 130/min CVP 18 Lactate 12 Cardiogenic

  16. BP 70/50 HR 140/min CVP 15 Lactate 12 Obstructive VTED OAD DLD

  17. BP 70/40 HR 140/min CVP 5 Lactate 12 Distributive

  18. SHOCK - • DEFINITION • CAUSES • EFFECTS OF INEFFECTIVE TREATMENT • ASSESSMENT • MEASUREMENT • CLINICAL APPROACH

  19. EFFECTS OF INEFFECTIVE TREATMENT MISERY !!! INFECTION

  20. SHOCK - • DEFINITION • CAUSES • EFFECTS OF INEFFECTIVE TREATMENT • ASSESSMENT • MEASUREMENT • CLINICAL APPROACH

  21. SHOCK: asssessment • Class 1&2 vs 3&4 • needs blood or crystalloid ?

  22. Sublingual capnometry: • A new noninvasive measurement for diagnosis and quantitation of severity of circulatory shock • Max Harry Weil MD, PhD, FCCM - CCM 1999 hypercarbia is a universal indicator of critically reduced tissue perfusion.

  23. Sublingual capnometry: • A new noninvasive measurement for diagnosis and quantitation of severity of circulatory shock

  24. Sublingual capnometry: • A new noninvasive measurement for diagnosis and quantitation of severity of circulatory shock

  25. Sublingual capnometry: • A new noninvasive measurement for diagnosis and quantitation of severity of circulatory shock P SL CO2 provides a prompt indication of the reversal of tissue hypercarbia when circulatory shock is reversed

  26. SHOCK - • DEFINITION • CAUSES • EFFECTS OF IEFFECTIVE TREATMENT • MEASUREMENT • CLINICAL APPROACH

  27. SHOCK: an EMERGENCY !!! GOAL: RAPIDLY RESTORE TISSUE PERFUSION • Recognize it !!! • Immediate stabilization: ABC • ……. SHOTGUN approach • ICU & Surgical consultation • Treat the cause

  28. Management prioritiesin hypoperfused states BP potency: Dopamine...NE…Vasopressin/Phenylephrine

  29. PATIENT ENROLLMENT

  30. PROTOCOL

  31. RESULTS

  32. RESULTS

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