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Shock

Shock. Dr. Abdullah M. Kaki , MB ChB, FRCPC Department of Anesthesia, Faculty of Medicine, King Abdulaziz University. Objectives of the Lecture. To provide an up-to-date understanding of the types of shock To understand the current pathophysiology of shock

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Shock

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  1. Shock Dr. Abdullah M. Kaki, MB ChB, FRCPC Department of Anesthesia, Faculty of Medicine, King Abdulaziz University

  2. Objectives of the Lecture • To provide an up-to-date understanding of the types of shock • To understand the current pathophysiology of shock • To discuss some therapeutic options for shock

  3. Definition • French term , Choc (Le Dran- 1743) • Systemic derangement in tissue perfusion leading to wide spread of cellular hypoxia and vital organs dysfunction.

  4. 37 yr male involved in RTA,(driver), brought to ER by Paramedics • BP 90/50 mmHg, HR 120/min, RR 28/min • Perfuse sweating, pallor, tenderness over chest & upper abdomen • What is wrong with him? D Dx? • What LAB investigation is required for the Dx? • What is your plan for treatment?

  5. 52 yr Diabetic female patient admitted with foot ulcer for debridement. 2 days later pt developed fever, confusion and they called you to assess the patient. • What is your approach? • What is plan for treatment?

  6. 22 yr male patient came to ER with renal colic, your colleague prescribed an antibiotic & pain killer for him. • On administration of his medicine, he collapses. What is your approach?

  7. 75 year old female admitted to the hospital 4 days ago with chest pain, S.O.B., diagnosed as MI & was started. • Early this morning the patient developed hypotension, tachycardia, SOB • What is wrong with her?

  8. Types of Shock • Hypovolemic • Distributive • Obstructive • Cardiogenic

  9. Shock Features Septic Cardiogenic Hypovolemic Blood Pressure ↓ ↓ ↓ Heart rate ↑ ↑ ↑ Respiratory rate ↑ ↑ ↑ Mentation ↓ ↓ ↓ Urine output ↓ ↓ ↓ Arterial pH ↓ ↓ ↓ Is cardiac out[put reduced? No Yes Yes Pulse pressure ↑ ↓ ↓ Diastolic pressure ↓↓↓ ↓ ↓ Extremities/ Digits Warm Cool Cool Nailbed return Rapid Slow Slow Heart sounds Crisp Muffled Muffled Temperature ↑ or ↓ ↔ ↔ White cell count ↑ or ↓ ↔ ↔ Site of infection + + - - Is the heart too full? No Yes No Symptoms/clinical context Sepsis/liver failure Angina / ECG Hemorrhage/dehydration Jugular venous pressure ↓ ↑ ↓ S3, S4, gallop rhythm - + + + - Respiratory crepitation - + + + - Chest X-ray Normal Large heart, ↑upper lobe flow, pulmonary edema Normal

  10. Pathophysiology of Shock • Oxygen Delivery: • PaO2 • Hb • CO • CO = SV X HR

  11. Compensatory & Decompensatory Mechanisms • Autonomic Nervous System • Hormonal mechanism • Peripheral Vascular system • Myocardial Depression • Transcapillary refill • Down regulation of Catecholamines receptors

  12. The mainstay of shock therapy Improving Oxygen Delivery: (by raising hemoglobin concentration, cardiac output, or arterial saturation). Reduce Oxygen Consumption. Identify and treat the precipitants of hypoperfusion.

  13. Therapeutic Options • Early Diagnosis • Need for ICU • Identification of Cause • Prevention: *Aseptic Technique * Monitoring *Perioperative Antibiotics *Vaccination

  14. Fluid Resuscitation • Colloids vs Crystalloids • Fluid replacement • Augmentation of SV • Fluid • Inotropes • Vasodilators

  15. Future Directions • Better Outcome: Advanced monitoring and ICU facilities. • More patients: elderly, major surgeries, more infection & more invasive devices. • Outlook is bright as we are unrevealing the secrets of shock.

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