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Shock, Dr.Syed Alam Zeb

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Shock, Dr.Syed Alam Zeb

  1. 1. SHOCK
  2. 2. Essentials of Diagnosis <ul><li>Low systolic BP and tachycardia. </li></ul><ul><li>Peripheral vasoconstriction and in most cases vasoconstriction. </li></ul><ul><li>Altered mental status. </li></ul><ul><li>Oliguria or Anuria. </li></ul><ul><li>Metabolic Acidosis. </li></ul>
  3. 3. DEFINITION <ul><li>Inadequate arterial circulation to meet tissue metabolic needs. </li></ul><ul><li>Treat the cause and the manifestations. </li></ul>
  4. 4. CLASSIFICATION <ul><li>1. HYPOVOLEMIC SHOCK </li></ul><ul><li>Loss of blood, external or internal </li></ul><ul><li>Loss of plasma, burns Loss of fluids & electrolytes, external or internal. </li></ul>
  5. 5. <ul><li>2. CARDIOGENIC SHOCK </li></ul><ul><li>Dysrhythmia Pump failure Acute valvular dysfunction Ventricular wall or septum rupture </li></ul>
  6. 6. <ul><li>3.OBSTRUCTIVE SHOCK </li></ul><ul><li>Tension pneumothorax Pericardial disease Pulmonary embolism..massive Cardiac tumor Obstructive valvular disease </li></ul>
  7. 7. <ul><li>4. DISTRIBUTIVE SHOCK </li></ul><ul><li>Septic shock </li></ul><ul><li>Anaphylactic shock </li></ul><ul><li>Neurogenic shock </li></ul><ul><li>Vasodilator drugs </li></ul><ul><li>Acute adrenal insufficiency </li></ul>
  8. 8. DIAGNOSIS OF SHOCK <ul><li>Hypotention..systolic BP <90 mm hg </li></ul><ul><li>Orthostatic changes..drop in systolic BP of >10-20mm hg with an > in pulse rate of 15. </li></ul><ul><li>Peripheral hypoperfusion..weak/absent pulses & cold extremities. </li></ul><ul><li>Altered mental status..restless, confused, drowsy or comatose. </li></ul>
  9. 9. TREATMENT OF SHOCK <ul><li>DEPENDS ON: </li></ul><ul><li>Cause/type </li></ul><ul><li>Severity </li></ul><ul><li>Duration </li></ul><ul><li>Underlying conditions influencing the onset or maintenance of shock. </li></ul>
  10. 10. Treatment cont: <ul><li>Position </li></ul><ul><li>Oxygenation </li></ul><ul><li>Analgesics </li></ul><ul><li>Iv line </li></ul><ul><li>Urine flow </li></ul><ul><li>Monitor cardiac rhythm </li></ul>
  11. 11. Treatment cont: Lab. Investigations FBC,blood type & cross match, blood urea, sugar, S. electrolytes, and blood gases.
  12. 12. Treatment cont: <ul><li>Central venous pressure (CVP) or Pulmonary Capillary Wedge Pressure . </li></ul><ul><li>Important for adequate fluid replacement </li></ul>
  13. 13. Treatment cont: <ul><li>Volume Replacement…depends what has been lost: </li></ul><ul><li>Crystalloids </li></ul><ul><li>Colloids </li></ul><ul><li>Blood and plasma fractions </li></ul>
  14. 14. Treatment cont: <ul><li>Vasoactive Drugs ..should not be considered a primary form of therapy in shock. </li></ul><ul><li>Dopamine Dobutamine </li></ul>
  15. 15. Treatment Cont: <ul><li>Corticostroids ..controversial role. </li></ul><ul><li>Antibiotics according to culture and sensitivity. </li></ul>
  16. 16. SEPTIC SHOCK <ul><li>Febrile patient with chills and hypotension. </li></ul><ul><li>Gram negative septicemia. </li></ul><ul><li>Initial vasoconstriction followed by vasodilatation, warm shock. </li></ul><ul><li>Treat the cause & provide supportive treatment. </li></ul>
  17. 17. SUMMARY <ul><li>Identify and treat the primary cause of shock. </li></ul><ul><li>Give adequate fluids to have good urinary out put. </li></ul><ul><li>Intensive monitoring of the vital signs. </li></ul><ul><li>Steroids and vasoactive drugs..not the primary treatment. </li></ul>

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