shock alnasser abdulaziz alomari mohammed alhomoud homoud
DESCRIPTION
WHAT IS SHOCK? Shock is the term used to describe acute circulatory failure with inadequate or inappropriately distributed tissue perfusion resulting in generalized cellular hypoxia and/or an inability of the cells to utilize oxygen. 3TRANSCRIPT
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SHOCK
Alnasser AbdulazizAlomari MohammedAlhomoud Homoud
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Objective Definition .Pathophysiology .Sign and symptoms .Types of shock .Management .Summery .
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WHAT IS SHOCK?
Inadequate Tissue
Perfusion
• Shock is the term used to describe acute circulatory failure with inadequate or inappropriately distributed tissue perfusion resulting in generalized cellular hypoxia and/or an inability of the cells to utilize oxygen.
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PATHOPHYSIOLOGY OF SHOCK
• The manifestation of shock reflects both –The impaired perfusion of body tissue
& –The body’s attempt to maintain tissue
perfusion (compensatory mechanism)
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Inadequate tissue perfusion
Decreased oxygen supply
Anaerobic metabolism
Accumulation metabolic waste & lactate
Cellular failure (limited ATP produce)
Pathophysiology of shockcellular responses
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VICIOUS CYCLE Hypoperfusion
Cellular injury
Inflammatory mediators
Functional & structural changes in microvascular
circulation
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Global Tissue Hypoxia
• Endothelial inflammation and disruption• Inability of O2 delivery to meet demand• Result:
• Lactic acidosis• Cardiovascular insufficiency• Increased metabolic demands
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Symptoms of Shock
• Anxiety /Nervousness
• Dizziness• Weakness• Faintness• Nausea & Vomiting• Thirst• Confusion• Decreased UO
• Hx of Trauma / other illness
• Vomiting & Diarrhoea
• Chest Pain• Fevers / Rigors• SOB
General Symptoms Specific Symptoms
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Signs of ShockPale
Cold & Clammy skin SweatingCyanosis
TachycardiaTachypnoea
Confused / AggiatatedUnconsciousHypotensiveStridor / SOB
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TYPES OF SHOCK
HYPOVOLEMIC
CARDIOGENIC
DISTRIBUTIVE
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Hypovolaemic
• Volume Loss
• Blood loss -HaemorrhagePlasma Loss -Burns ECF Loss - Vomiting & Diarrhoea
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Compensatory mechanism and shock
Fluid
Volume
(CVP/JVP)
Vascular
Diameter
(SVR)
Cardiac
Output
(SV x HR)
PRE-LOAD AFTER-LOAD
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Hypovolaemic shock
Fluid
Volume
(CVP/JVP)
Vascular
Diameter
(SVR)
Cardiac
Output
(SV x HR)
PRE-LOAD AFTER-LOAD
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Hypovolaemic shock
Fluid
Volume
(CVP/JVP)
Vascular
Diameter
(SVR)
Cardiac
Output
(SV x HR)
PRE-LOAD AFTER-LOAD
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Hypovolaemic shock
Fluid
Volume
(CVP/JVP)
Vascular
Diameter
(SVR)
Cardiac
Output
(SV x HR)
PRE-LOAD AFTER-LOAD
312
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Hypovolaemic shock Management
• Hemorrhage: Arrest of bleeding & fluid resuscitation.
• Two wide bore (14-16 gauge) peripheral venous access.
• Crystalloid infusion- titrated to clinical response.
• PRBCs: Life threatening/ continued bleeding.
• Diagnosis & treatment: Source of bleeding/ other causes
• Invasive monitoring.
• Urine output monitoring- Foley catheter
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Cardiogenic
• Pump FailureMay be due to – Inability of heart to Contract or– Inability of heart to pump blood
• Myocardial damage ( M.I)• Arrhythmias• Valvular damage
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Compensatory mechanism and shock
Fluid
Volume
(CVP/JVP)
Vascular
Diameter
(SVR)
Cardiac
Output
(SV x HR)
PRE-LOAD AFTER-LOAD
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Cardiogenic shock
Fluid
Volume
(CVP/JVP)
Vascular
Diameter
(SVR)
Cardiac
Output
(SV x HR)
PRE-LOAD AFTER-LOAD
1
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Cardiogenic shock
Fluid
Volume
(CVP/JVP)
Vascular
Diameter
(SVR)
Cardiac
Output
(SV x HR)
PRE-LOAD AFTER-LOAD
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Cardiogenic shock
Fluid
Volume
(CVP/JVP)
Vascular
Diameter
(SVR)
Cardiac
Output
(SV x HR)
PRE-LOAD AFTER-LOAD
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Cardiogenic Shock management
• Maintenance of adequate oxygenation.• Carful fluid administration to avoid fluid
overload.• Cardiology consultation.• Thoracocenteasis, pericardiocentesis in
trauma.
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Distributive
• Decreased Peripheral Vascular Resistance
• Septic Shock (inflammatory mediators)• Neurogenic Shock (loss of sympathetic control
on vascular tone)• Anaphylactic shock (presence of vasodilator
substances like histamine)
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Compensatory mechanism and shock
Fluid
Volume
(CVP/JVP)
Vascular
Diameter
(SVR)
Cardiac
Output
(SV x HR)
PRE-LOAD AFTER-LOAD
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Distributive shock
Fluid
Volume
(CVP/JVP)
Vascular
Diameter
(SVR)
Cardiac
Output
(SV x HR)
PRE-LOAD AFTER-LOAD
1
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Distributive shock
Fluid
Volume
(CVP/JVP)
Vascular
Diameter
(SVR)
Cardiac
Output
(SV x HR)
PRE-LOAD AFTER-LOAD
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Distributive shock
Fluid
Volume
(CVP/JVP)
Vascular
Diameter
(SVR)
Cardiac
Output
(SV x HR)
PRE-LOAD AFTER-LOAD
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septic shock management
• Crystalloid infusion ( target CVP ≥8 mmHg).• Urine output: ≥0.5 ml/kg/hr.• Vasopressors(noradrenaline):Persistent hypotension, after
volume restoration- • Serum lactate: Monitor tissue perfusion.• Identification of underlying infection: History, examination &
investigations (blood culture, radiological).• Treatment of infection: IV antibiotics(empirical, post-culture)
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Neurogenic shock management
• Airway secured, adequate ventilation.
• Fluid resuscitation to restore intravascular volume.
• Administration of vasopressor.
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Anaphylactic shock management
• Stop administration of causative agent.
• Maintain airway, give 100% O₂.
• Adrenaline 0.5-1 mg IM.
• IV crystalloid.
• 2nd line: Antihistamine- chlorphenamine 1—20 mg slow IV or
Hydrocortisone 200 mg IV
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Shock Types & Physiology
Shock CVP CO PVRHypovolemic ↓ ↓ ↑Septic ↓ ↑ ↓Cardiogenic ↑ ↓ ↑Neurogenic ↓ ↓ ↓Anaphylactic ↓ ↑ ↓
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Thank you