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shock in truma patient

shock in truma patient. Dr.Kefaya Abdulmalek. Definition. Types of shock. Clinical diagnosis. Management. Definition. Circulatory shock is a process in which blood flow and oxygen delivery to tissues are disturbed. B pr = C.O X SVR. Types of shock. Hypovolemic (hemorrhagic).

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shock in truma patient

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  1. shock in truma patient Dr.Kefaya Abdulmalek

  2. Definition. • Types of shock. • Clinical diagnosis. • Management.

  3. Definition • Circulatory shock is a process in which blood flow and oxygen delivery to tissues are disturbed. • B pr = C.O X SVR.

  4. Types of shock • Hypovolemic (hemorrhagic). • Obstructive: 1- Tension pneumothorax. 2- Massive PE. 3- cardiac Temponade. • Distributive: 1- Neurogenic. 2- septic. 3- anaphylactic. • Cardiogenic: 1- contusion. 2- Dissecting aortic valve. 3- MI (rare).

  5. diagnosis • Clinical. • Biochemical.

  6. Clinical diagnosis • ↓ mental status. • Tachycardic, Tachypnic, hypotensive. • Diaphoretic. • Cold , hypoperfused skin. Except in distributive shock. • Oligouria.

  7. Biochemical diagnosis • Acidosis (metabolic). • ↓ mixed venous saturation. • Base deficit. • Impairment of renal function+/- liver funtion.

  8. Management A B C

  9. Indication for intubation • Hypoxemia. • Ventilatory failure(  CO2, signs of muscle fatigue. • Obtundaion. • Vital organ hypoperfusion.

  10. Inserting a central line is a must

  11. Please Fill the tank

  12. Volume restoration is the first msg. exceptin florid pulmonary edema. • Use 500 cc normal saline to do so preferred with rapid infuser or Pr bag. • If head truma with signs of  ICP give 250 cc of 3%S as a bolus.

  13. Hemorrhagic shock • Continue to fill the tank with fld( NS,RL, colloid (hestril 10 / 6 % , heamacell) • Till you get the blood products. Even if you need to give un matched blood. • OR un grouped blood when it is really life threting. • Young tolerate hct 20-25%, old with IHD up to 30%.

  14. How much? till you get enough BPr. & urine out put.

  15. but some times • Hard to achieve. • So? • Vassopresor.

  16. What vassopresor? Nor Epi.

  17. Tension pneumothorax • 14- gauge needle 2nd space mid clavicular. • Chest tube.

  18. Cardiac Temponade pericadiocentesis

  19. Massive PE • Fat embolism ?

  20. Anaphylactic SC EPI (0.3 – 0.5 mg) of 1: 1000 solution.

  21. Distributive shock • Fld……. Fld ………. Fld. • Nor-Epi.

  22. Pump failure ( cardiogenic) • Inotrope ( doputamine ). + • Vassopresor.

  23. MI / severe contusionbut not A I IABP

  24. THANK YOU

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