Circulatory shock

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    Low output circulatory failure, affects CO (by decreasing EDV due to decreased venous return.)
  • <number>
    CO severely reduced due to heart dysfunction (“pump failure”)
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  • Circulatory shock

    1. 1. Barry Kidd 2010 1 CirculatoryCirculatory SHOCKSHOCK
    2. 2. 2Barry Kidd 2010 DefinitionDefinition Inadequate perfusion (oxygen supply) of tissues,Inadequate perfusion (oxygen supply) of tissues, resulting in:resulting in:  Organ dysfunctionOrgan dysfunction  Cellular and organ damageCellular and organ damage And if not quickly corrected…And if not quickly corrected…  DeathDeath
    3. 3. 3Barry Kidd 2010 Causes of Shock – a quick list:Causes of Shock – a quick list:  Heart AttackHeart Attack  AnaphylaxisAnaphylaxis  Loss of Circulating Blood Volume (bleeding ,Loss of Circulating Blood Volume (bleeding , burns, dehydration)burns, dehydration)  Venous Dilation (allergy, pain, drugs, heatVenous Dilation (allergy, pain, drugs, heat stroke, infection)stroke, infection)  High or Low Body TemperatureHigh or Low Body Temperature
    4. 4. 4Barry Kidd 2010 Signs of ShockSigns of Shock  Pulse: Rapid, weak, threadyPulse: Rapid, weak, thready  TachycardiaTachycardia  RespirationsRespirations  Shallow, irregular, laboredShallow, irregular, labored  May be tachypnea (increased respiratory rate.)May be tachypnea (increased respiratory rate.)
    5. 5. 5Barry Kidd 2010 Signs of ShockSigns of Shock  Due to hypoperfusion:Due to hypoperfusion:  Decreased “mentation” - confused, sluggish, anxiousDecreased “mentation” - confused, sluggish, anxious  Skin cold, mottledSkin cold, mottled
    6. 6. 6Barry Kidd 2010 Emergency TreatmentEmergency Treatment  Evaluate vital signsEvaluate vital signs  BP, Respiration Rate, Pulse Oximeter, Temp.BP, Respiration Rate, Pulse Oximeter, Temp.  Control bleedingControl bleeding  Prevent loss of body heatPrevent loss of body heat
    7. 7. 7Barry Kidd 2010 Causes of Shock:Causes of Shock: Classification (the real list)Classification (the real list)  Low Output Circulatory FailureLow Output Circulatory Failure  Hypovolemic shock (too little volume)Hypovolemic shock (too little volume)  Cardiogenic shock (pump failure)Cardiogenic shock (pump failure)  Obstructive shockObstructive shock  Distributive shock: Venous poolingDistributive shock: Venous pooling  High Output Circulatory FailureHigh Output Circulatory Failure  Distributive Shock: Sepsis, toxic shock,Distributive Shock: Sepsis, toxic shock, anaphylaxis:anaphylaxis:
    8. 8. 8Barry Kidd 2010 Hypovolemic ShockHypovolemic Shock  CO reduced due to loss of intravascularCO reduced due to loss of intravascular VOLUMEVOLUME  Reduced venous returnReduced venous return  CausesCauses  Most often, blood loss (hemorrhage)Most often, blood loss (hemorrhage)  DehydrationDehydration  BurnsBurns  Fluid lost into peritoneal cavity w/Fluid lost into peritoneal cavity w/ pancreatitispancreatitis
    9. 9. 9Barry Kidd 2010 Cardiogenic ShockCardiogenic Shock  Myocardial Infarction (most frequent cause)Myocardial Infarction (most frequent cause)  Acute Valvular Dysfunction – e.g. papillaryAcute Valvular Dysfunction – e.g. papillary muscle rupture post-MImuscle rupture post-MI  Arrhythmia – e.g., heart block, ventricularArrhythmia – e.g., heart block, ventricular tachycardiatachycardia
    10. 10. 10Barry Kidd 2010 Obstructive ShockObstructive Shock  CO reduced by vascular obstruction:CO reduced by vascular obstruction:  Obstruction of Venous return (vena cava syndromeObstruction of Venous return (vena cava syndrome – usually neoplasms)– usually neoplasms)  Compression of the heart (pericardial tamponade*)Compression of the heart (pericardial tamponade*)  Outflow from heart (Massive pulmonary embolism,Outflow from heart (Massive pulmonary embolism, aortic dissection)aortic dissection)
    11. 11. 11Barry Kidd 2010 Obstructive ShockObstructive Shock  CO reduced by vascular obstruction:CO reduced by vascular obstruction:  Obstruction of Venous return (vena cavaObstruction of Venous return (vena cava syndrome – usually neoplasms)syndrome – usually neoplasms)  Compression of the heart (pericardialCompression of the heart (pericardial tamponade*)tamponade*)  Outflow from heart (Massive pulmonaryOutflow from heart (Massive pulmonary embolism, aortic dissection)embolism, aortic dissection)
    12. 12. 12Barry Kidd 2010 Pericardial TamponadePericardial Tamponade  Life threateningLife threatening condition caused by fluidcondition caused by fluid (blood, effusion fluid)(blood, effusion fluid) under pressure aroundunder pressure around the heart.the heart.  Decreases CO byDecreases CO by decreasing fillingdecreasing filling  Causes includeCauses include pericarditis and MIpericarditis and MI
    13. 13. 13Barry Kidd 2010
    14. 14. 14Barry Kidd 2010 Distributive ShockDistributive Shock  Maldistribution of flowMaldistribution of flow  Two Categories:Two Categories:  Low Output - Venous pooling due to loss ofLow Output - Venous pooling due to loss of venous tonevenous tone  High Output Circulatory FailureHigh Output Circulatory Failure
    15. 15. 15Barry Kidd 2010 Venous PoolingVenous Pooling  A Low Output Circulatory FailureA Low Output Circulatory Failure  Often due to spinal shock or drug overdoseOften due to spinal shock or drug overdose  Behaves like hypovolemic shockBehaves like hypovolemic shock  CO severely reduced because blood is pooledCO severely reduced because blood is pooled in peripheral veins, rather than returned toin peripheral veins, rather than returned to heartheart
    16. 16. 16Barry Kidd 2010 Distributive Shock: High OutputDistributive Shock: High Output  Cardiac Output is normal or elevated;Cardiac Output is normal or elevated; distribution inappropriatedistribution inappropriate  Shock is due to loss of vascular resistanceShock is due to loss of vascular resistance  Examples:Examples:  Sepsis, Toxic Shock:Sepsis, Toxic Shock:  Bacterial endotoxin triggers vasodilationBacterial endotoxin triggers vasodilation  AnaphylaxisAnaphylaxis
    17. 17. 17Barry Kidd 2010 AnaphylaxisAnaphylaxis
    18. 18. 18Barry Kidd 2010 Anaphylactic ShockAnaphylactic Shock  Histamine triggers vasodilation, increasedHistamine triggers vasodilation, increased capillary permeabilitycapillary permeability  Can lead to low-output distributive shockCan lead to low-output distributive shock
    19. 19. 19Barry Kidd 2010 Physiological Response to ShockPhysiological Response to Shock  The pressure drop is compensated for byThe pressure drop is compensated for by regulatory mechanismsregulatory mechanisms  This = “Nonprogressive” / “Compensated”This = “Nonprogressive” / “Compensated” ShockShock
    20. 20. 20Barry Kidd 2010 Progressive ShockProgressive Shock  Compensatory mechanisms inadequate toCompensatory mechanisms inadequate to compensate for loss of blood volumecompensate for loss of blood volume  Cardiac circulation compromisedCardiac circulation compromised  decreaseddecreased heart functionheart function  decreased flowdecreased flow  Positive feedback cycle: Shock worsensPositive feedback cycle: Shock worsens  lessless compensationcompensation  shock worsens…shock worsens…  Clotting in small vesselsClotting in small vessels  Vessels dilate and permeability increasesVessels dilate and permeability increases
    21. 21. 21Barry Kidd 2010 Irreversible ShockIrreversible Shock  Cardiac and other tissue irreversibly damagedCardiac and other tissue irreversibly damaged  Characterized by:Characterized by:  Decreasing cardiac functionDecreasing cardiac function  Progressive blood vessel dilationProgressive blood vessel dilation  Progressive increase in vessel permeabilityProgressive increase in vessel permeability
    22. 22. 22Barry Kidd 2010 Irreversible ShockIrreversible Shock  Cardiac and other tissues are irreversiblyCardiac and other tissues are irreversibly damageddamaged  Characterized by:Characterized by:  Decreasing cardiac functionDecreasing cardiac function  Progressive blood vessel dilationProgressive blood vessel dilation  Progressive increase in vessel permeabilityProgressive increase in vessel permeability
    23. 23. 23Barry Kidd 2010 The SHOCK Of Your Life ! SUMMARYSUMMARY
    24. 24. 24Barry Kidd 2010 Physiology Basic unit of life = cell Cells get energy needed to stay alive by reacting oxygen with fuel (usually glucose) No oxygen, no energy No energy, no life
    25. 25. 25Barry Kidd 2010 Flow = Perfusion Adequate Flow = Adequate Perfusion Inadequate Flow = Indequate Perfusion (Hypoperfusion) Hypoperfusion = Shock
    26. 26. 26Barry Kidd 2010 Circulatory Shock “Pathophysiologic state in which tissue perfusion is totally inadequate to meet the oxygen or nutritional needs of the cells” Shock described as “momentary pause in the act of death” Shock is not a disease entity in itself, but a response to some assault or injury the body has experienced Whatever the initiating event, the cause of death in irreversible shock is microcirculatory failure and the subsequent depression of cellular metabolism
    27. 27. 27Barry Kidd 2010 What is needed to maintain perfusion? Pump Pipes Fluid Heart Blood Vessels Blood
    28. 28. 28Barry Kidd 2010 How can perfusion fail? Pump Failure Pipe Failure Loss of Volume
    29. 29. 29Barry Kidd 2010

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