This is a detailed study about shock , myocardial infraction , & stroke . also contain descriptions about types of shock, further management ,recognition of shock , treatment, first aid options are also mentioned along with cardiac arrest and stroke & emergency management of stroke etc please comment if you visited this thank u

1. SHOCK, MAYOCARDIAL
IINFARCTION AND
STROKE
MARTIN SHAJI
PHARM D

2. SHOCK
Is a life threatening medical condition of low
blood perfusion resulting in cellular injury and
inadequate tissue function.

3. SHOCK: Description
• The circulatory system distributes blood to all parts of the
body, carrying oxygen and nutrients to the tissues.
• If the circulatory system fails, and insufficient oxygen
reaches the tissues, the medical condition known as
shock occurs.
• If the condition is not treated quickly, the vital organs can
fail, ultimately causing death. Shock is made worse by
fear and pain.
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4. Shock description contd.
• The heart pumps the blood around the body and through
the blood vessels. If an area of the body requires more
blood, the blood vessels control the flow of blood by either
dilating (opening), or constricting (closing). The blood
itself transports oxygen and vital nutrients to the body’s
cells (perfusion), while carrying away waste products such
as carbon dioxide.
• The blood vessels must constrict or dilate in a manner
that balances out the blood flow. If an area of the body
requires more blood (the legs when exercising for
example), other vessels located elsewhere in the body
must constrict to supply the amount of blood needed.
• An interruption or imbalance to any one part of the
circulatory system, results in shock.
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5. Types of Shock
There are four major types of shock
• hypovolemic shock,
• cardiogenic shock
• distributive shock.
• Obstructive shock
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6. 1.Hypovolemic shock
•Hypovolemic shock is a medical
and surgical condition in which
the rapid fluid loss results in
multiple organ failure due to
inadequate circulating volume
and subsequent inadequate
perfusion.
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7. Hypovolemic shock cont….
-bleeding can occur as a result raptured ectopic
pregnancy, bleeding peptic ulcers, blunt trauma, placenta
abruption, severe trauma, Bleeding anywhere in the
gastrointestinal tract
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8. Management of hypovolemic shock
• Keep patient warm and comfortable
• Set up an iv line for Fluid replacement; saline or colloid
initially. If bleeding use blood
• Treat underlying cause
• Monitor urine output(normal is 0.5ml/kg/hr)

9. 2. Cardiogenic shock
• Is a state of inadequate tissue perfusion primarily due to
cardiac (heart) dysfunction.
• Defect in cardiac function.

10. Cardiogenic shock causes
• Myocardial infarction
• Arrhythmias
• Myocarditis
• Valve distraction (endocarditis)

11. 3.Distributive shock…
• Medical condition in which results from excessive
vasodilation and impaired distribution of blood flow.
• Septic shock is the most common form of distributive
shock. Other causes of distributive shock include
i)systemic inflammatory response syndrome (sirs) due to
non infectious inflammatory conditions such as burns,
ii)anaphylaxis reactions (anaphylactic shock) due to drugs
or toxins or insect bites or transfusion reaction
iii)neurogenic shock due to brain or spinal cord injury

12. Systemic inflammatory response
syndrome(sirs)
SIRS is the presence of two or more of the following
features;
-temperature >38 or <36 degrees Celsius
-tachycardia >90bpm
-respiratory rate >20breaths /minute
-white blood cell count >12000000000/l or <4000000000/l

13. sepsis
• IS SIRS occurring in the presence of an infection
• Severe sepsis is sepsis with evidence of organ hypo
perfusion e.g. oliguria, altered cerebral function,
hypoxemia etc.

14. SEPTIC SHOCK
• Is Severe sepsis with hypotension (systolic bp <90mmHg)
despite adequate fluid resuscitation.
• Patients usually have warm extremities apart from other
general signs of shock
• Management; give antibiotics. Give iv fluids. Monitor
vitals.

15. Anaphylactic shock
• Inappropriate vasodilation caused by an allergen
• Precipitants include drugs (e.g. penicillin), latex,
stings,eggs,fish,peanuts etc.
• Signs and symptoms include itching, sweating, diarrhea,,
edema, wheeze, tachycardia,hypotension,cyanosis

16. Neurogenic shock
• Caused by major brain or spinal injury
• Caused by sudden loss of signals from the sympathetic
nervous system that maintain normal muscle tone in
blood vessels
• Hence the blood vessels relax and become dilated
resulting in pooling of blood in the venous system and an
overall decrease in blood pressure

17. 4.Obstructive shock
• Obstruction to blood flow around the circulation e.g
pulmonary embolism, cardiac tamponed, tension
pneumothorax
• Caused by Conditions that block the flow of blood in and
out of the heart.

18. Management of shock generally
• Check blood pressure
• Raise foot unless its cardiogenic shock
• Set up an iv line..2large bore iv cannulas
• Identify and treat underlying cause
• Give iv fluids most likely crystalloid to raise bp (unless
cardiogenic shock)
• See expert help early

19. Cont….
Investigations
-full blood count, urea and creatinine levels, blood
glucose,CRP
-cross Mach and check clotting time
-blood culture, urine culture,ecg,chest xray

20. Further management…
Put catheter to monitor urine output
Treat underlying cause if possible
Fluid replacement after checking urine output or blood
pressure
If persistently hypotensive, consider giving inotropic drugs

21. Recognition of Shock
Initially, a flow of adrenaline causes:
• A rapid pulse.
• Pale, grey skin, especially inside the lips. If pressure is applied to a
fingernail or earlobe, it will not regain its colour immediately.
• Sweating, and cold, clammy skin (sweat does not evaporate).
•
• As shock develops, there may be:
•
• Weakness and giddiness.
• Nausea, and sometimes vomiting.
• Thirst.
• Rapid, shallow breathing.
• A weak, ‘thready’ pulse. When the pulse at the wrist disappears, fluid
loss may equal half the blood volume
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22. Recognition of Shock contd.
• As the oxygen supply to the brain weakens:
•
• The casualty may become restless, anxious and
aggressive.
• The casualty may yawn and gasp for air (‘air
hunger’).
• The casualty will eventually become unconscious.
• Finally, the heart will stop.
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23. Shock Severity
• There are three classifications of shock severity;
compensated shock, decompensated shock and
irreversible shock.
• In compensated shock, a condition that is reversible with
medical care, the body attempts to compensate for the
loss of perfusion.
Symptoms of compensated shock include:
• increased heart rate
• the redistribution of blood flow to essential areas such as
the brain and the heart
• a stimulation of the nervous system that causes the
bronchial airways to open increasing the breathing rate
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24. Shock severely contd.
• In decompensated shock, also reversible with
medical intervention, the body can no longer
compensate for the loss of blood and fluids.
Symptoms of decompensated shock include:
• decreased blood pressure
• fast heart rate
• confusion or unconsciousness
• skin becomes cold, clammy and can appear blue
• breathing becomes rapid and shallow
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25. Irreversible Shock
• Irreversible shock is the final stage of shock and cannot
be medically treated, resulting in death. In this stage of
shock, damage to organs has occurred that cannot be
reversed. Medical intervention may help to prolong life for
awhile, but inevitably at some point, a person will die.
Symptoms of irreversible shock include:
• a slow erratic heart rate
• coma
• pale, cold and clammy skin
• severely low blood pressure
• decreased breathing
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26. Treatment of Shock
• DO NOT let the casualty move unnecessarily, eat,
drink, or smoke.
• DO NOT leave the casualty unattended.
Reassure the casualty constantly.
• Treat any cause of shock which can be remedied
(such as external bleeding).
• Lay the casualty down, keeping the head low.
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27. Treatment contd
• Raise and support the casualty’s legs (be careful
if suspecting a fracture).
• Loosen tight clothing, braces, straps or belts, in
order to reduce constriction at the neck, chest
and waist.
• Insulate the casualty from cold, both above and
below. Contact the emergency service.
• Check and record breathing, pulse and level of
response. Be prepared to resuscitate the
casualty if necessary.
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28. FirstAid for Shock Before Emergency Care
• Check for signs of circulation (breathing,
coughing or movement). If absent, begin CPR.
• Give Rescue Breaths or CPR as needed.
• Lay the person flat, face-up, but do not move him
or her if you suspect a head, back, or neck injury.
• Raise the person's feet about 12 inches. Use a
box, chair etc.
• Do not raise the feet or move the legs if hip or leg
bones are broken. Keep the person lying flat.
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29. First aid care contd.
• If the person vomits or has trouble breathing, raise him or
her to a half-sitting position (if no head, back, or neck
injury).
• Or, turn the person on his or her side to prevent choking.
• Loosen tight clothing. Keep the person warm. Cover the
person with a coat, blanket, etc.
• Monitor for a response. - Repeat as needed.
• Do not give any food or liquids. If the person wants water,
moisten the lips.
• Reassure the person. Make him or her as comfortable as
you can.
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30. HOW TO RECOGNIZE
OTHER MAJOR
EMERGENCIES

31. Heart Attack
Myocardial infarction
• Coronary heart disease is the leading cause of death in our nation.
• During MI - part of heart muscle is starting to die.
• Caused by a blockage of an artery (coronary) due to buildup of cholesterol
deposits or a blood clot.
• Coronary arteries supply blood to the heart muscle.When an artery is blocked, for
example by a blood clot, the muscle beyond the blockage is deprived of oxygen and
other nutrients carried by the blood, and begins to die.
• Victims are usually awake and can talk but feels severe pain
• Most critical time is within the first 30 minutes after Sx begin.

32. Heart Attack
• Most common symptoms
• Pain or pressure in the center of the chest – which last more
than 3-5 minutes.
• Pain might feel pressure, fullness, squeezing, or heaviness
• Pain might spread to shoulder, neck, lower jaw and down arm
(usually the right).
• Pain lasts 3-5 minutes. Sometimes will stutter, stop
momentarily but then begin again.
• Other Symptoms – lightheadedness, fainting, sweating
without fever, nausea, shortness of breath
• Most victims will downplay symptoms, you must take action!!!

33. What to do / emergency management of
myocardial infarction
• 1. Call 911 for emergency help. Tell the dispatcher that
you suspect a heart attack. If the casualty asks you to do
so, call his own doctor too.
• 2. Make the casualty as comfortable as possible to ease
the strain on his heart. A half sitting position, with his head
and shoulders supported and his knees bent, is often
best. Place cushions behind him and under his knees.
• 3. Assist the casualty to take up to one full-dose adult
aspirin tablet (325 mg) or four baby aspirin (81 mg each).
Advise him to chew it slowly
• 4. Monitor and record vital signs— as well level of
response, breathing, and pulse .while waiting for help.
Stay calm to avoid undue stress.

34. Cardiac Arrest
• When the heart stops beating. Usually
caused by VF, which begins where the heart
muscle is injured.
• Without blood flow and no pulse the person
becomes unconscious and stops breathing
and collapses.
• VF and cardiac arrest may be the only
symptom of a heart attack.
• AED is only thing that will stop a VF

35. Stroke
• A stroke or brain attack is a medical emergency that occurs when
the blood supply to the brain is disrupted.
• Strokes are the third most common cause of death in the US and
many people live with long-term disability as a result of a stroke.
• This condition is more common later in life and is associated with
disorders of the circulatory system, such as high blood pressure.
• The majority of strokes are caused by a clot in a blood vessel that
blocks the flow of blood to the brain. However, some strokes are the
result of a ruptured blood vessel that causes bleeding into the brain.
• If a stroke is due to a blood clot, it may be possible to give drugs to
limit the extent of damage to the brain and improve recovery. The
earlier the casualty receives care in the hospital, the better.
• Presentation or symptoms vary depending on which area of the
brain has been affected.. Its is a rapid onset of neurological
problems like weakness, paralysis in one or more limbs, difficulty
speaking, visual problems, intense dizziness, facial weakness, altered
consciousness, and severe headache.

36. Stroke
• Use the FAST (Face-Arm-Speech-
Time) guide if you suspect a
• casualty has had a stroke:
• F – Facial weakness—the casualty is
unable to smile evenly and the mouth
or eye may be droopy
• A – Arm weakness—the casualty is
only able to raise one of his arms
• S – Speech problems—the casualty is
unable to speak clearly or may not
understand the spoken word
• T – Time to call 991 for emergency
help if you suspect that the casualty
has had a stroke.

37. What to do/ emergency management of
stroke
• 1. Look at the casualty’s face. Ask him to smile; if he has had a stroke
he may only be able to smile on one side—the other side of his mouth
may droop
• 2. Ask the casualty to raise both his arms; if he has had a stroke, he
may be able to lift only one arm.
• 3. Find out whether the person can speak clearly and understand
what you say. When you ask a question, does he respond
appropriately to you?
• 4. Call 991 for emergency help. Tell the dispatcher that you have
used the FAST guide and you suspect a stroke.
• 5. Keep the casualty comfortable and supported. If the casualty is
conscious, you can help him lie down. Reassure him that help is on
the way.
• 6. Regularly monitor and record vital signs— as well as level of
response, breathing, and pulse while waiting for help to arrive. Do not
give the casualty anything to eat or drink because it may be difficult
for him to swallow.

38. THANK YOU VERY MUCH
HAVE A LOVELY DAY!