SHOCK.pdf

A serious condition where insufficient blood flow reaches the body tissues. Definition an emergency and one of the leading causes of death for critically ill people. Failure of blood circulating system to deliver sufficient oxygen to tissues Causes Intravascular deficit Myocardial pump failure Pe...

A serious condition where insufficient blood flow reaches the body tissues. Definition an emergency and one of the leading causes of death for critically ill people. Failure of blood circulating system to deliver sufficient oxygen to tissues Causes Intravascular deficit Myocardial pump failure Peripheral vasodilation bleeding from the gastrointestinal tract external trauma ruptured ectopic pregnancy Excessive blood loss Fertilized egg develops outside of the uterus ruptured aortic aneurysm haemoperitoneum Bleeding in peritoneal cavity burns surgery severe vomiting Hypovolaemic Shock diarrhoea Causes Decreased circulating blood volume burns diabetes mellitus External loss diabetes insipidus excessive use of diuretics diuretic phase of acute renal failure Excessive fluid loss extensive muscle injury peritonitis pancreatitis Internal sequestration of fluid intestinal obstruction ascites Acute myocardial infarction cardiac arrhythmias acute aortic Cardiogenic Shock ruptured interventricular septum Causes Decreased pumping function of the heart myocardial rupture Types myxoma progressive myocarditis myocardial depression Septic shock Types Neurogenic shock Anaphylactic shock Barbiturate poisoning Distributive Shock It is relative hypovolemia due to vasodilation Acute spinal cord injury Anaesthesia Causes Drugs like nitrates Calcium-channel blockers Ganglion blockers Adrenergic blocking agents Pericardial tamponade Extracardiac obstructive shock Excessive Fluid Accumulation in pericardial sac Decrease in Filling of cardiac chambers Decrease in cardiac output Constrictive pericarditis Causes Massive pulmonary embolism Severe pulmonary hypertension SHOCK Thirst Symptoms Weakness Light - headedness Hypotension SBP less than 90 mm Hg Tachycardia Hypothermia Oliguria Signs Dark-yellow colored urine Confusion and coma Organ dysfunction High Blood lactate ( Anaerobic metabolism) Normal Saline 0.9% NaCl Na Cl Crystalloids (Electrolyte-Base solutions) fluids with electrolytes compositions approximates plasma or have a total osmolality similar to plasma (280 - 295 mmol/kg) Lactated Ringer K Ca Lactate Na Cl Plasma - Lyte A K Mg Acetate Colloids (Large molecular weights solutions) Albumin They are associated with fluid overload, renal dysfunction and bleeding Hydroxyethyl starch Fluid therapy Dextran Whole blood They used with patients who looses more than 1500 ml blood from hemorrhage. Types Packed red blood cells Fresh frozen plasma (FFP) Platelet Blood products They are associated with virus transmission, hypocalcaemia, increased blood viscosity Hypothermia Recommendations All fluids must be warmed to 37 before using to prevent: Arrhythmia Coagulopathy Blood transfusion Drug of choice for anaphylactic shock and 2nd choice for septic shock It stimulates beta 1 receptors in the heart which increase heart rate MOA It stimulates alpha 1 receptors results in vasoconstriction (high dose) It also stimulates beta 2 receptors (low dose) Epinephrine has a rapid onset but a brief duration of action (due to rapid degradation). The preferred route is intramuscular Pharmacological Treatment hypovolemic shock In emergency situations, epinephrine is given intravenously (IV) for the most rapid onset of action Epinephrine Pharmacokinetics It may also be given subcutaneously and by inhalation It is rapidly metabolized by MAO and COMT, and the metabolites metanephrine and vanillylmandelic acid are excreted in urine Dose Infusion rates of 0.04 – 1mcg/kg/min Hypertension Dysrhythmias Side Effects Angina Nervousness Tremor It is the drug of choice in septic shock. It stimulates alpha1 receptors results in vasoconstrictions MOA It has minor activity to beta 1 receptors so it increase cardiac output to a certain extent It has a weak beta 2 effects Norepinephrine is given IV for rapid onset of action Norepinephrine Vasopressors and Inotropies Pharmacokinetics The duration of action is 1 to 2 minutes It is rapidly metabolized by MAO and COMT, and inactive metabolites are excreted in the urine required in patients with shock when volume resuscitation fails to maintain adequate blood pressure and organ and tissues remain hypo-perfused It is initialed at 0.05 to 0.1 mcg/kg/min, the increased till reach the MAP goals Dose Side Effects Hypertension Dysrhythmia Used for treatment of shock, sepsis, heart failure and renal failure It stimulates alpha1 receptors results in vasoconstrictions MOA It stimulate beta 1 receptors so it increase cardiac output and heart rate It stimulate doapamergic receptors which helps to increase renal perfusion which helps in renal failure Dopamine dilates renal and splanchnic arterioles by activating dopaminergic receptors, thereby increasing blood flow to the kidneys and other viscera Dopamine Renal and visceral effects dopamine is clinically useful in the treatment of shock which significant increases in sympathetic activity might compromise renal function Dose Side Effects IV – 5-15 μg/kg/min Angina Dysrhythmias It used for treatment of cardiogenic shock and heart failure MOA It stimulate beta 2 It also stimulate beta 1 receptors, so it increase cardiac output with less effect on heart rate Dobutamine Dose 2-20 mcg/kg/min Hypertension Side Effects Angina Dysrhythmias