1 / 36

shock

shock. Definition. Hypotension. “ Hypoperfusion can be present in the absence of significant hypotension.”. Pathophysiology. ATP production Na-K pump Anaerobic metabolism acidosis. Physiological Response. Clinical picture. Signs of Organ Hypoperfusion

tress
Télécharger la présentation

shock

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. shock

  2. Definition

  3. Hypotension “Hypoperfusion can be present in the absence of significant hypotension.”

  4. Pathophysiology ATP production Na-K pump Anaerobic metabolism acidosis

  5. Physiological Response

  6. Clinical picture Signs of Organ Hypoperfusion Multiorgan Dysfunction Syndrome (MODS) Result is end organ failure

  7. Goals of Shock Resuscitation - Approach - Monitoring

  8. Airway

  9. Control Work of Breathing

  10. Optimizing Circulation -Crystalloids vs Colloids

  11. End Points of Resuscitation“Goal-directed therapy” Use objective hemodynamic and physiologic values to guide therapy Urine output > 0.5 mL/kg/hr CVP 8-12 mmHg MAP 65 to 90 mmHg Central venous oxygen concentration > 70%

  12. In general, treat the cause...

  13. Categories

  14. Hypovolemic Shock -Causes: Non-hemorrhagic Hemorrhagic -Signs

  15. Classes of Hypovolemic Shock

  16. Cardiogenic Shock -Causes -Signs

  17. Coronary PP = DBP - PAOP GOAL - Coronary PP > 50 mm Hg

  18. AMI • Aspirin, beta blocker, morphine, heparin • If no pulmonary edema, IV fluid challenge • If pulmonary edema • Dobutamine • Dopamine – will ↑ HR and thus cardiac work • PCI or thrombolytics • RV infarct • Fluids and Dobutamine (no NTG) • Acute mitral regurgitation • Pressors (Dobutamine and Nitroprusside) If inotropes and vasopressors fail, intra-aortic balloon pump

  19. Distributive Shock -Types : -Signs :

  20. Sepsis • Two or more of SIRS criteria • Temp > 38 or < 36 C • HR > 90 • RR > 20 • WBC > 12,000 or < 4,000 Plus • presumed existence of infection

  21. Treatment

  22. Septic Shock Sepsis Plus refractory hypotension After bolus of 20-40 mL/Kg.

  23. -Consider Vasopressors-Consider adrenal insufficiency

  24. Vasopressors • Assure adequate fluid volume • Administer via central venous line • Do not use dopamine for renal protection • Requires arterial line placement • Vasopressin: • Refractory shock

  25. Anaphylaxis IgE Mediated Hypersensitivity (type 1) -causes: -Anaphylactoid reaction:

  26. Signs • Biphasic phenomenon occurs in up to 20% of patients : Symptoms return 3-4 hours after initial reaction has cleared • Symptoms usually begin within 60 minutes of exposure • Faster the onset of symptoms = more severe reaction • A “lump in my throat” and “hoarseness” heralds life-threatening laryngeal edema

  27. Treatment • ABC’s • IVFs, oxygen • Epinephrine • Bronchodilators Magnesium sulfate • Second line • Corticosteriods • H1 and H2 blockers

  28. Neurogenic shock -Occurs after acute spinal cord injury -Any injury above T1 can disrupt the entire sympathetic system -usually lasts from 1 to 3 weeks

  29. Treatment A,B,Cs Fluid resuscitation Vasopressors Treat bradycardia Methylprednisolone

  30. Adrenal Crisis Causes Autoimmune adrenalitis Adrenal apoplexy = hemorrhage or infarct

  31. Treatment

  32. Obstructive Shock -Causes -Signs

  33. Summary Type PAOP C.O. SVR HYPOVOLEMIC  CARDIOGENIC  DISTRIBUTIVE  or N varies  OBSTRUCTIVE   

  34. The End

More Related