Shock (Lecture 1) PDF

Shock IV SEMESTER 2 ND YEAR Monday: 10:30 am to12:30 Ms. Ruquia Feroz Lecturer and Section Head Resp....

Shock IV SEMESTER 2 ND YEAR Monday: 10:30 am to12:30 Ms. Ruquia Feroz Lecturer and Section Head Resp. Critical Care ,DIMT ,DUHS This work is licensed under a Creative Commons Attribution- NonCommercial-NoDerivatives 4.0 International License. 1  Objectives At the end of this lecture students will be able to: Understand and describe circulatory shock Overview the basic pathophysiology of circulatory shock Know and evaluate the causes ,sign and symptoms of circulatory shock Know how to diagnose and manage the patient with circulatory shock Overview the classification of circulatory shock This work is licensed under a Creative Commons Attribution- NonCommercial-NoDerivatives 4.0 International License. 2 Shock: Definition Shock is defined as “An acute clinical syndrome resulting when cellular dysoxia occurs, ultimately leading to  Organ dysfunction and  Failure And if not quickly corrected…  Death This work is licensed under a Creative Commons Attribution- 3 NonCommercial-NoDerivatives 4.0 International License. Shock: Definition  Shock is a physiologic state characterized by systemic reduction in tissue perfusion, resulting in decreased tissue oxygen delivery. This work is licensed under a Creative Commons Attribution- 3 NonCommercial-NoDerivatives 4.0 International License.  Flow = Perfusion Adequate Flow = Inadequate Flow = Adequate Perfusion Indequate Perfusion (Hypoperfusion) Hypoperfusion = Shock What happened if Shock occur? Anaerobic? Anaerobic? So So What? What? Inadequate Inadequate Cellular Cellular Oxygenation Oxygenation Inadequate Inadequate Anaerobic Anaerobic Lactic LacticAcid Acid Energy Energy Metabolism Metabolism Production Production Production Production Metabolic Metabolic Metabolic Metabolic Cell CellDeath! Death! Failure Failure Acidosis Acidosis Shock – Effects on Organ  Heart – ↓ CO / hypotension / myocardial depressants  Lung - ↓gas exchange / tachypnoea / pulmonary edema  Endocrine – ADH → ↑ reabsorption of water  CNS – perfusion ↓ – drowsy  Blood - Coagulation abnormalities – DIC  Renal - ↓ GFR - ↓ urine output  GIT – mucosal ischaemia – bleeding & hepatic - ↑ enzyme levels Hypovolemic Etiology  Blood loss  Haemorrhage  Plasma / body water loss  Electrolytes imbalance  Vomiting  Diarrhea  Dehydration This work is licensed under a Creative Commons Attribution- NonCommercial-NoDerivatives 4.0 International License. 8 Cardiogenic Etiology Valvular heart disease Myocardial infarction Cardiac arrhythmias Cardiomyopathy 9 Obstructive Etiology Cardiac Tamponade Pulmonary Embolism Tension Pneumothorax Air embolism 10 Neurogenic Etiology Paraplegia Quadriplegia Trauma to spinal cord Spinal anesthesia 11 Anaphylactic Etiology Injections – Penicillins Anaesthetics Stings Shelfish 12 Septic Etiology Gram + Gram – Fungi / Virus Protozoa 13 Signs and Symptoms of Shock Decreased LOC, anxiety, disorientation. Tachycardia, decreased SBP and pulse pressure Rapid shallow breathing Cold, pale, clammy, diaphoretic, cyanotic skin, decreased capillary refill time. Decreased urine output 14 Stages of shock Initial : The cells become leaky and switch to anaerobic metabolism. Non-progressive: (compensated stage) Attempt to correct the metabolic upset of shock. Progressive: (decompensated stage ) Eventually the compensation will begin to fail. Refractory : Organs fail and the shock can no longer be reversed. 15 Diagnosis and Evaluation Clinical Signs Primary diagnosis Tachycardia Tachypnea Oliguria Encephalopathy (confusion) Peripheral hypoperfusion (spotted, poor capillary refill vs. hyperemic and warm) Hypotension 16  Blalock Classification Of Shock Shock Neurogenic Hypovolemic Cardiogenic Vasogenic Anaphylactic Septic Shock classifications HYPOVOLEMIC Hemorrhagic Trauma, gastrointestinal, retroperitoneal Nonhemorrhagic Dehydration, emesis, diarrhea, fistulae, burns, polyuria,malnutrition, large open wounds CARDIOGENIC Myocardial Infarction, contusion, myocarditis, cardiomyopathies, pharmacologic Mechanical Valvular failure, ventricular septal defect, ventricular wall defects Arrhythmias 18 T H A N K YOU Please visit your LMS D U H S for course material and announcements. This work is licensed under a Creative Commons Attribution- NonCommercial-NoDerivatives 4.0 International License.