Post on 31-Dec-2015
description
What is shock?
‘Clinical syndrome in which the circulation is unable to deliver adequate end organ
perfusion resulting in cellular hypoxia and eventually irreversible cellular injury’
How do I know my patient is shocked?
• Look unwell
• Tachycardic
• May be hypotensive
• Signs of inadequate organ perfusion- low UO- raised lactate- confusion
How do I treat shock?
• A-E assessment
• Treat as you find
• Large bore IV access
• Fluid resuscitation
• Search for cause and specific treatment
Hypovolaemic
• Commonest type
• Insufficient circulatory volume
• Bleeding, vomiting, burns, dehydration
• Resuscitate with IV fluid
• Treat underlying cause (e.g.: surgery if bleeding)
Classification of Hypovolaemic Shock
Class I Class II Class III Class IV
Volume Loss 0-15% 15-30% 30-40% >40%
RR 15-20 20-30 30-40 >40
HR <100 >100 >120 >140
BP Normal Normal Low Very Low
CNS Normal Anxious Confused Lethargic
UO Normal Low normal Oliguric Anuric
Treatment Crystalloid Crystalloid Crystalloid/Blood Blood
Distributive
• Neurogenic- trauma- failure of sympathetic nervous system to maintain vascular tone
• Septic- history suggestive of infection- raised temperature
Sepsis 6
1. High flow oxygen
2. Take blood cultures
3. Broad spectrum IV antibiotics
4. IV fluid resuscitation
5. Measure Hb and Lactate
6. Monitor hourly urine output
Obstructive
• Prevention of blood flow from the heart
• Cardiac tamponade, tension pneumothorax, massive PE
• Signs- dilated neck veins- muffled heart sounds- unilaterally decreased breath sounds- deviated trachea
Cardiogenic
• Commonly seen post MI
• Signs- history suggestive- dilated neck veins- pulmonary oedema
• Caution with fluids
• Inotropes (e.g.: dopamine, dobutamine)
Summary
• Shock is common
• Shock can be life threatening
• Can be treated by doing the basics well
• Four main types- Hypovolaemic- Distributive- Obstructive- Cardiogenic