Basics of circulatory shock

1. Circulatory
Shock
Qedirya Ahmed
Halder Jamal
November 7th, 2023

3. Shock?
Shock is the inability to provide suf
fi
cient
perfusion of oxygenated blood and nutrients
to meet metabolic demands of tissues
causing end organ damage.

4. Distributive
Hypovolemic
Obstructive
Cardiogenic

5. Distributive
Hypovolemic Obstructive
Cardiogenic
• Sepsis
• Anaphylaxis
• Neurogenic:
- Deep GA
- Cord injury
- Brain ischemia*
• Hemorrhage
• Diarrhea
• Burns
• Adrenal crisis
• DKA
• DI
• CHD
• Arrhythmias
• Myocarditis
• Kawasaki
• CMP
• Hypoxia*
• T. Pneumothorax
• Tamponade
• Massive PE
Dissociative
• CO poisoning
• Methemoglobinemia

8. • Septic shock: In early stages of sepsis when cytokine release
results in vasodilation, pulses may be bounding and vital organ
function may be maintained (an alert patient, with rapid capillary
re
fi
ll and some urine output in warm shock).
• Anaphylactic shock: cause (like medication, food, bee sting) Skin
rash,
fl
ushing , urticaria , angioedema, wheezing.
• Cardiogenic shock: Pulmonary edema, Hepatomegaly, JVD.
• Obstructive shock: Hepatomegaly, JVD.
Speci
fi
c Features

9. Resuscitation: ABCs
Trendelenberg position
Fluids:
• Bolus dose (20 mL/kg/20 min), repeat until there is response.
• Be very careful with cardiogenic shock (10 mL/ kg /1 h)
Treat the underlying cause:
• Septic: antibiotics, norepinephrine.
• Anaphylactic: antihistamines, hydrocortisone, epinephrine.
• Cardiogenic: DC shock, inotropes (epinephrine, norepinephrine,
dobutamine, dopamine)
• Last option: Hydrocortisone 2-5 mg/kg.
• Obstructive: needle decompression, surgical embolectomy.
Treatment

10. Acute renal shutdown:
• Best prevented by aggressive
fl
uid replacement.
• If RFT remain elevated → ATN
• With
fl
uids being replaced, give loop diuretic
• Dialysis is needed for refractory hyperkalemia, acidosis,
hypervolemia, uremic encephalopathy.
Respiratory failure:
• Endotracheal intubation with mechanical ventilation
Treatment

11. MOSF / MODS:
• Respiratory failure
• Renal failure
• Liver failure
• Coagulopathy
• Encephalopathy
• Anoxic brain injury
• Higher mortality
• Longer hospital stay
• Long term disability
Complications

13. Don’t let any patients die
without steroids