Shock

Tom Munford

CT2 Anaesthesia

Nottingham City Hospital

Outline

• What is shock?

• Types of shock

• Treatment

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’

Components of the Circulatory system

PUMP

PIPES FLUID

ORGANS

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

Types of shock

Hypovolaemic

Distributive

Cardiogenic

Obstructive

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

Needle Decompression

Pericardiocentesis

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

QUESTIONS?