1 / 15

Shock

Shock. Differential Diagnosis and Hemodynamic Monitoring. By Dr. Ishara Maduka M.B.B.S .(Colombo). Shock is a Cardiovascular Derangement. 1. Deliver Oxygen and Metabolic Substrates 2. Remove Products of Cellular Metabolism 3. Thermoregulation Definition :

emalloy
Download Presentation

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 Differential Diagnosis and Hemodynamic Monitoring By Dr. Ishara Maduka M.B.B.S.(Colombo)

  2. Shock is a Cardiovascular Derangement. 1. Deliver Oxygen and Metabolic Substrates 2. Remove Products of Cellular Metabolism 3. Thermoregulation Definition: A physiological state characterized by a significant, systemic reduction in tissue perfusion, resulting in decreased tissue oxygen delivery and insufficient removal of cellular metabolic products, resulting in tissue injury. Shock

  3. Classification of Shock • Hypovolemic • Septic/Inflammatory • Cardiogenic (Intrinsic, compressive & Obstructive) • Neurogenic • Anaphylactic

  4. Brachial systolic blood pressure: <110mmHg • Sinus tachycardia: >90 beats/min • Respiratory rate: <7 or >29 breaths/min • Urine Output: <0.5cc/kg/hr • Metabolic acidemia: [HCO3]<31mEq/L or base deficit>3mEq/L • Hypoxemia: 0-50yr: <90mmHg; 51-70yr: <80mmHg; >71yo<70mmHg; • Cutaneous vasoconstriction vs. vasodilation. • Mental Changes: anxiousness, agitation, indifference, lethargy, obtundation Clinical Markers of Shock

  5. Hypovolemic Shock • Decreased preload->small ventricular end-diastolic volumes -> inadequate cardiac generation of pressure and flow • Causes: • -- bleeding: trauma, GI bleeding, ruptured aneurysms, hemorrhagic pancreatitis • -- protracted vomiting or diarrhea • -- adrenal insufficiency; diabetes insipidus • -- dehydration

  6. Hypovolemic Shock • Signs & Symptoms: Hypotension, Tachycardia, Oliguria, Low volume Pulses. • Markers: monitor UOP,CVP, BP, HR, Hct,CO, lactic acid and PCWP • Treatment: ABCs, IVF (crystalloid), Transfusion Stem ongoing Blood Loss • Patients on β-blockers, w/ spinal shock & athletes may not be tachycardic

  7. Septic/Inflammatory Shock • Mechanism: release of inflammatory mediators leading to • Disruption of the microvascular endothelium • Cutaneous arteriolar dilation and increased capillary permeability • Causes: • Anaphylaxis, drug, toxin reactions • Trauma: crush injuries, major fractures, major burns. • infection/sepsis: G(-/+ ) speticemia,pneumonia, peritonitis, meningitis, cholangitis, pyelonephritis, necrotic tissue, pancreatitis, wet gangrene, toxic shock syndrome, etc.

  8. Septic/Inflammatory Shock Signs: Early– warm peripheries with vasodilatation, often adequate urine output, febrile, tachypnoeic. Late-- vasoconstriction, hypotension, oliguria, altered mental status.

  9. Mechanism: Intrinsic abnormality of heart -> inability to deliver blood into the vasculature with adequate power Cardiogenic Shock • Causes: • Cardiomyopathies: myocardial ischemia, myocardial infarction, cardiomyopathy, myocardiditis, myocardial contusion • Mechanical: cardiac valvular insufficiency, papillary muscle rupture, septal defects, aortic stenosis • Arrythmias: bradyarrythmias (heart block), tachyarrythmias (atrial fibrillation, atrial flutter, ventricular fibrillation) • Obstructive disorders: PE, tension peneumothorax, pericardial tamponade, constrictive pericaditis, severe pulmonary hypertension

  10. Cardiogenic Shock • Characterized by high preload (CVP) with low CO • Signs: Dyspnea, rales, loud P2 gallop, low BP, oliguria

  11. Neurogenic Shock Mechanism: Loss of autonomic innervation of the cardiovascular system (arterioles, venules, small veins, including the heart) • Causes: • Spinal cord injury • Regional anesthesia • Drugs • Neurological disorders

  12. Neurogenic Shock • Characterized by loss of vascular tone & reflexes. • Signs: Hypotension, Bradycardia, Accompanying Neurological deficits.

  13. Monitoring Adjuncts in Shock • Sphyngmomanometry • Pulse Oximeter • Arterial Line • Central Venous Line (Triple Lumen, Pulmonary Artery Catheter)

  14. Questions • List the types of shock. • List the clinical features of shock. • Briefly explain the pathophysiology of each type of shock.

  15. Thank You!

More Related