Post on 13-Jan-2016
ShockPresented by Dr Azza Serry
Learning objectives
Definition Pathophysiology Types of shockStages of shockClinical presentationmanagement
Types of shock
Shock Shock is inadequate tissue perfusion leading to decreased oxygen delivery to tissues .
typesHypovolaemicCardiogenicObstructiveDistributive
Hypovolaemic shock
Hypovolaemic shockTissue hypoperfusion resulting from inadequate intravascular volume .
Caused by reduced circulatory volume due to haemorrhage or fluid loss .
Haemorrhage : external , internal
Fluid loss : vomiting ,diarrhea ,burns.
Haemorrhagic shock classification
Class I Class II Class III Class VI
Volume loss (ml )
0 - 750 750 - 1000 1500 - 2000 ≥ 2000
Loss % 0 - 15 15 -30 30 - 40 ≥ 40
Pulse beats / min
< 100 > 100 > 120 > 140
Blood pressure
unchanged unchanged decreased decreased
Pulse pressure
unchanged decreased decreased decreased
Urine output ml / h
> 30 20 - 30 5 -15 anuric
Respiratory rate / min
14 -20 20 - 30 30 -40 > 40
Mental state
restless Anxious Anxious - confused
confused
Fluid replacement
Crystalloid Crystalliod & colloid
Colloid & blood
Colloid & blood
Cardiogenic shock
Cardiogenic shock Inadequate blood flow to vital organs due to inadequate cardiac output despite normal blood volume .
Caused by : acute myocardial infarction ,arrhythmia , myocarditis
.
Obstructive shock
Obstructive shockReduction of preload due to mechanical obstruction of cardiac contractility .
Caused by cardiac tamponade ,tension pneumothorax , pulmonary embolism .
.
Distributive shock
Disrtributive shock there is inadequate tissue perfusion accompanied by vascular dilatation ,with hypotension and decrease peripheral vascular resistance .
Anaphylaxis : antigen antibody reaction → histamine release →
vasodilatation → ↓PVR .
.
High spinal cord injury : interruption of sympathetic outflow → VD .
Septic shock
Septic shock
Tissue hypoperfusion that occurs in the presence of systemic inflammatory response to infection .
Gram negative , gram positive bacteria .
Intraperitoneal abscess , genitourinary infections .central line infection .
hypovolemic
cardiogenic
obstructive
distributive
Cardiac output
↓ ↓ ↓ ↑
Heart rate ↑ ↑ ↑ ↑
Blood pressure
↓ ↓ ↓ ↓
Peripheral vascular resistance
↑ ↑ ↑ ↓
Venous pressure
↓ ↑ ↑ ↓
Skin temperature
↓ ↓ ↓ ↑
acidosis √ √ √ √
Stages of shockCompensated shock Early , compensatory sympathetic stimulation
Altered level of consciousness ,
Increased pulse rate
Increase respiratory rate
Pale clammy skin
Normal blood pressure
Decompensated shocklate stage
Body looses ability to compensate
Rapid weak pulse
Shallow respiration
Extreme weakness
Pallor ,cyanosis
Drop in blood pressure
oliguria
Irreversible shock
Terminal stage Organs suffer prolonged hypoxia Return of function is irreversible despite aggressive adequate intervention
Unresponsiveness Profound hypotension Severe bradycardia Apnea Fixed dilated pupils
Presentation
Shock presents by Altered mental status Hypotension Increased pulse rate Increased respiratory rateOliguriaCold pale skin ,warm skin is seen in distributive shock
Manifestation of cause
Principles of management
General management principles1. Golden hour .
2. Establish clear airway ,adequate ventilation
3. Oxygen
4. Adequate intravenous access
5. Continuous cardiac monitoring
6. Urinary catheter
7. Record fluid balance
8. Maintain optimum temperature
9. Blood gases
10.Inotropes and vasoconstrictors may be used
11.Assess the response
12.Treat underlying cause.