Shock is defined as inadequate organ perfusion and tissue oxygenation. It can be caused by hypovolaemia from blood loss, cardiac issues, or neurogenic factors. The body activates compensatory mechanisms through the cardiovascular, renal, respiratory, and cerebral systems but these fail over time without treatment. Signs of shock include decreased consciousness, fast heart rate, pale skin, and low urine output. Treatment involves fluid resuscitation, controlling bleeding, and monitoring the patient's color, breathing, pulse, and consciousness. Without adequate treatment, shock leads to multiple organ failure and death.
Shock is defined as inadequate tissue perfusion due to reduced cardiac output, which can lead to organ dysfunction and high mortality if not treated early. Tissue perfusion depends on mean arterial pressure and cardiac output. There are four categories of shock depending on the cause of reduced cardiac output: hypovolemic, cardiogenic, distributive, and obstructive. Early intervention is needed to support physiological compensatory mechanisms and reverse the causes of shock through measures like fluid resuscitation and vasopressor drugs in order to prevent progression to refractory shock.
Shock is defined as inadequate tissue perfusion due to reduced cardiac output, which can lead to organ dysfunction and high mortality if not treated early. Tissue perfusion depends on mean arterial pressure and cardiac output. There are four categories of shock depending on the cause of reduced cardiac output: hypovolemic, cardiogenic, distributive, and obstructive. Early intervention is needed to support physiological compensatory mechanisms and reverse the causes of shock through measures like fluid resuscitation and vasopressor drugs in order to prevent progression to refractory shock.
Cardiogenic shock is a life-threatening condition where the heart is unable to pump enough blood to meet the body's needs. It is usually caused by heart muscle damage from a myocardial infarction, cardiomyopathy, or other acute cardiac conditions. Key features include low blood pressure, rapid heart rate, impaired thinking, and poor peripheral circulation. Treatment focuses on supporting heart function through inotropic drugs or devices, reducing workload on the heart, and treating any underlying causes.
power point presentation on shock management.pptxAregashAcha
Shock is a medical emergency characterized by inadequate tissue perfusion leading to cellular dysfunction. It can be caused by issues related to blood volume, cardiac function, vasodilation, or obstruction of blood flow. The main goals in treatment are to restore circulating volume and tissue perfusion through intravenous fluids, blood products, vasopressors if needed, and treating the underlying cause. Early recognition and treatment are important to prevent multiple organ failure and death.
Presentation on clinical signs of hypovolemic shock and the best ways to approach stabilizing these patients before sending them on to a referral center with more sophisticated equipment for treating such cases.
1. The document discusses pediatric shock, including its definition, types, pathophysiology, signs, investigations, and management.
2. The main types of shock discussed are hypovolemic, cardiogenic, distributive, obstructive, and septic shock.
3. Management of shock involves rapid recognition and resuscitation through fluid administration, vasopressors, and addressing metabolic abnormalities to restore adequate tissue perfusion.
Shock is a life-threatening condition where tissues do not receive adequate oxygen due to low blood flow. There are three stages of shock: compensatory, progressive, and refractory. Shock can be classified as hypovolemic, cardiogenic, neurogenic, anaphylactic, or septic depending on the cause. Treatment focuses on restoring adequate circulation through fluid resuscitation, vasopressors, or inotropes while also treating the underlying cause of shock.
Shock is defined as inadequate tissue perfusion due to reduced cardiac output, which can lead to organ dysfunction and high mortality if not treated early. Tissue perfusion depends on mean arterial pressure and cardiac output. There are four categories of shock depending on the cause of reduced cardiac output: hypovolemic, cardiogenic, distributive, and obstructive. Early intervention is needed to support physiological compensatory mechanisms and reverse the causes of shock through measures like fluid resuscitation and vasopressor drugs in order to prevent progression to refractory shock.
Shock is defined as inadequate tissue perfusion due to reduced cardiac output, which can lead to organ dysfunction and high mortality if not treated early. Tissue perfusion depends on mean arterial pressure and cardiac output. There are four categories of shock depending on the cause of reduced cardiac output: hypovolemic, cardiogenic, distributive, and obstructive. Early intervention is needed to support physiological compensatory mechanisms and reverse the causes of shock through measures like fluid resuscitation and vasopressor drugs in order to prevent progression to refractory shock.
Cardiogenic shock is a life-threatening condition where the heart is unable to pump enough blood to meet the body's needs. It is usually caused by heart muscle damage from a myocardial infarction, cardiomyopathy, or other acute cardiac conditions. Key features include low blood pressure, rapid heart rate, impaired thinking, and poor peripheral circulation. Treatment focuses on supporting heart function through inotropic drugs or devices, reducing workload on the heart, and treating any underlying causes.
power point presentation on shock management.pptxAregashAcha
Shock is a medical emergency characterized by inadequate tissue perfusion leading to cellular dysfunction. It can be caused by issues related to blood volume, cardiac function, vasodilation, or obstruction of blood flow. The main goals in treatment are to restore circulating volume and tissue perfusion through intravenous fluids, blood products, vasopressors if needed, and treating the underlying cause. Early recognition and treatment are important to prevent multiple organ failure and death.
Presentation on clinical signs of hypovolemic shock and the best ways to approach stabilizing these patients before sending them on to a referral center with more sophisticated equipment for treating such cases.
1. The document discusses pediatric shock, including its definition, types, pathophysiology, signs, investigations, and management.
2. The main types of shock discussed are hypovolemic, cardiogenic, distributive, obstructive, and septic shock.
3. Management of shock involves rapid recognition and resuscitation through fluid administration, vasopressors, and addressing metabolic abnormalities to restore adequate tissue perfusion.
Shock is a life-threatening condition where tissues do not receive adequate oxygen due to low blood flow. There are three stages of shock: compensatory, progressive, and refractory. Shock can be classified as hypovolemic, cardiogenic, neurogenic, anaphylactic, or septic depending on the cause. Treatment focuses on restoring adequate circulation through fluid resuscitation, vasopressors, or inotropes while also treating the underlying cause of shock.
Shock is defined as a physiologic state characterized by a significant reduction in systemic tissue perfusion due to decreased oxygen delivery. There are three main types of shock: hypovolemic, distributive, and cardiogenic. Hypovolemic shock results from decreased intravascular volume from blood or fluid loss. Distributive shock causes severe vasodilation, with septic, anaphylactic, and neurogenic shock as subtypes. Cardiogenic shock stems from cardiac pump failure due to conditions like heart attack or arrhythmias. The key treatments for shock involve fluid resuscitation, controlling blood loss, treating the underlying cause, and supporting organ perfusion and oxygen delivery with vasopressors or inot
The complication of shock with classificationsifengetachew12
This document contains lecture notes on circulatory shock. It defines shock as a state where there is widespread and serious reduction in tissue perfusion that can lead to impaired cellular function if prolonged. The document classifies and describes the causes, symptoms, and pathophysiology of different types of shock including hypovolemic, cardiogenic, obstructive, distributive (septic, anaphylactic, neurogenic), and discusses the body's compensatory mechanisms during shock like activation of the sympathetic nervous system and renin-angiotensin system. It outlines the progression from cellular hypoxia to organ dysfunction and failure if shock is not corrected.
Shock is a condition where circulation fails to meet the metabolic needs of tissues due to inadequate oxygen delivery. There are several types of shock based on etiology, including hypovolemic from blood/fluid loss, cardiogenic from heart failure, obstructive from pulmonary embolism, and septic from infection. Signs of shock range from mild with pale skin to severe with unconsciousness. Treatment focuses on restoring tissue perfusion through fluid resuscitation, vasopressors, and inotropes while also treating the underlying cause. The goals of resuscitation are to increase oxygen delivery and decrease oxygen demand through stabilization of vital signs and tissue perfusion markers.
The document discusses shock, including:
1. Circulatory shock occurs when the circulatory system is unable to provide adequate circulation and tissue perfusion, leading to cellular hypoxia and energy deficit.
2. Shock is classified as hypovolemic, cardiogenic, obstructive, or distributive. Hypovolemic shock results from blood or fluid loss while cardiogenic shock stems from heart problems reducing cardiac output.
3. During the reversible phase of hemorrhagic shock, compensatory mechanisms aim to maintain perfusion through vasoconstriction, tachycardia, fluid shifts, and hormonal responses. However, irreversible shock leads to organ dysfunction and failure without rapid intervention.
This document discusses shock, including its definition, pathophysiology, types, stages, and effects on body systems. Shock is defined as a failure of the circulatory system to maintain adequate organ perfusion. The main types are hypovolemic, cardiogenic, and distributive shock. The stages include initial, nonprogressive, progressive, and refractory. Effects include tissue hypoxia, acid-base imbalances, coagulopathies, and end-organ damage. General signs are tachypnea, tachycardia, hypotension, altered mental status, and oliguria. Early goal-directed resuscitation is important to prevent progression to irreversible shock.
1. Shock is defined as inadequate tissue perfusion to meet metabolic demand and can be caused by hypovolemia, cardiac dysfunction, obstruction of blood flow, or inappropriate blood vessel dilation.
2. Clinical signs of shock include tachycardia, abnormal capillary refill time, weak pulses, hypotension, and altered mental status.
3. Management of shock involves optimizing oxygen delivery through fluid resuscitation, antibiotics, vasopressors, ventilation, and treating the underlying cause to increase blood pressure and tissue perfusion.
This document discusses shock, which is a profound hemodynamic and metabolic disturbance characterized by failure of the circulatory system to maintain adequate organ perfusion. There are four main types of shock: cardiogenic, hypovolemic, distributive, and obstructive. The document outlines the etiology, pathophysiology, clinical presentation, diagnostic evaluation, and management of each type of shock. It emphasizes the importance of early goal-directed therapy and treatment of the underlying cause of shock to increase cardiac output and tissue perfusion in order to prevent multiple organ dysfunction.
Cardiogenic shock is defined as inadequate tissue perfusion due to cardiac dysfunction or hypo-perfusion of end organs due to cardiac failure. It has a high mortality rate of 50-80% and is most commonly caused by extensive acute myocardial infarction. Symptoms include cyanosis, decreased consciousness, and low blood pressure. Diagnosis involves identifying hypotension, low cardiac index, and signs of hypoperfusion on physical exam along with supportive tests like EKG, echocardiogram, and Swan-Ganz catheter. Treatment focuses on optimizing prefusion with vasopressors or inotropes, diuretics, emergent revascularization through cardiac catheterization, and mechanical circulatory support like IABP,
This document discusses different types of hemorrhage and shock, including:
1) Types of hemorrhage include external, internal, traumatic, and non-traumatic bleeding from various locations in the body.
2) Shock is classified as hypovolemic, cardiogenic, vasogenic, neurogenic, or mixed. Compensated shock involves tachycardia and anxiety while decompensated shock includes confusion and low blood pressure.
3) General management of shock includes maintaining an open airway, high oxygen, IV access, monitoring vitals, and controlling bleeding for hypovolemic shock. Fluid resuscitation is important but type and amount depends on shock classification.
This document provides information on shock, including its definition, physiology, pathophysiology, types, symptoms, signs, management, and treatment. It defines shock as inadequate perfusion leading to inadequate oxygen delivery to tissues. The stages of shock are described as initial, compensatory, progressive, and irreversible. Types of shock include cardiogenic, hypovolemic, neurogenic, septic, anaphylactic, and obstructive shock. Signs and symptoms result from cellular hypoperfusion and include restlessness, tachycardia, decreased consciousness, nausea, and decreased urine output. Management involves treating the underlying cause, giving oxygen, intravenous fluids, and vasopressors if needed. The goal of treatment is
This document defines shock and outlines its causes, consequences, diagnosis, and management. Shock is defined as reduced effective tissue perfusion leading to cellular and circulatory dysfunction. The main types of shock discussed are hypovolemic, cardiogenic, distributive, and obstructive shock. The consequences of shock include anaerobic metabolism, lactic acidosis, and ultimately organ dysfunction or failure if not treated. Diagnosis involves assessing for signs of hypoperfusion like decreased mental status and oliguria. Management focuses on restoring perfusion through fluid resuscitation and treating the underlying cause.
This document provides an overview of shock, including its classification, pathophysiology, stages, diagnostic studies, and collaborative care. Shock is defined as a syndrome characterized by decreased tissue perfusion and cellular metabolism due to an imbalance in oxygen supply and demand. The main types of shock discussed are cardiogenic, hypovolemic, neurogenic, anaphylactic, and septic shock. The stages of shock progression from initial to refractory are also outlined. Key aspects of shock management include identifying the cause, restoring perfusion through fluid resuscitation and vasoactive drugs if needed, and supporting failing organs.
Shock is a state of low tissue perfusion that can lead to cell death if not treated promptly. There are several types of shock including hypovolemic, cardiogenic, obstructive, distributive, and endocrine. The management of shock involves identifying the underlying cause, restoring adequate perfusion and oxygen delivery, and providing supportive care. Initial treatment consists of oxygen, IV fluids, and medications to support blood pressure and organ function while the root cause is addressed. Prompt recognition and treatment of shock is crucial to prevent organ damage and death.
This document discusses the identification and treatment of various types of shock states. It defines hypovolemic, distributive, cardiogenic, and septic shock and their clinical manifestations. Early diagnosis is key, involving history, physical exam assessing vital signs, perfusion, and urinary output. Treatment focuses on establishing airway, supplying oxygen, restoring circulating volume with fluids, and using vasopressors to improve cardiac output as needed based on the type and severity of shock. Children in particular can maintain blood pressure while showing signs of poor peripheral perfusion.
The document discusses different types of shock including cardiogenic shock, hypovolemic shock, and distributive shock. Cardiogenic shock is defined as inadequate pumping of the heart due to cardiac dysfunction or obstruction. It commonly occurs after myocardial infarction and has a high mortality rate. Hypovolemic shock results from inadequate circulating blood volume due to blood or fluid loss. Both types of shock can lead to organ dysfunction if not treated promptly with fluid resuscitation, vasopressors, and other supportive measures. The document provides details on the pathophysiology, clinical manifestations, diagnostic evaluation, and management of cardiogenic and hypovolemic shock.
The post-operative patient needs management of various issues including pain, delirium, respiratory compromise, cardiovascular issues, and infection. Major post-op issues stem from the body's stress response to surgery, including systemic inflammation, catabolism, insulin resistance, and fluid/electrolyte changes. Care requires monitoring for signs of organ dysfunction and providing support for individual organ systems while addressing surgery-specific concerns.
(5) nursing care plans (ncp) for cardiogenic shockMustafa Abdalla
The document provides information on cardiogenic shock, including its causes and nursing care plans. Cardiogenic shock is caused by the heart's inability to pump sufficiently due to impaired contractility. It is usually associated with conditions like myocardial infarction.
The nursing care plans for cardiogenic shock involve careful assessment, monitoring of vital signs and fluid status, and adjusting medications based on assessments. Five specific nursing care plans are outlined covering impaired gas exchange, decreased cardiac output, ineffective tissue perfusion, excess fluid volume, and anxiety. The plans describe potential signs and symptoms, desired outcomes, and nursing interventions with rationales.
This document provides an overview of neonatal shock and hypotension. It defines shock, discusses the pathophysiology including factors that influence cardiac output and blood flow to tissues. It describes the stages of shock, risk factors, clinical manifestations, evaluation and treatment including volume expanders and vasoactive drugs. Specific types of shock like hypovolemic, cardiogenic, distributive and their treatments are explained. Intractable shock and further care are also summarized.
Shock is defined as a physiologic state characterized by a significant reduction in systemic tissue perfusion due to decreased oxygen delivery. There are three main types of shock: hypovolemic, distributive, and cardiogenic. Hypovolemic shock results from decreased intravascular volume from blood or fluid loss. Distributive shock causes severe vasodilation, with septic, anaphylactic, and neurogenic shock as subtypes. Cardiogenic shock stems from cardiac pump failure due to conditions like heart attack or arrhythmias. The key treatments for shock involve fluid resuscitation, controlling blood loss, treating the underlying cause, and supporting organ perfusion and oxygen delivery with vasopressors or inot
The complication of shock with classificationsifengetachew12
This document contains lecture notes on circulatory shock. It defines shock as a state where there is widespread and serious reduction in tissue perfusion that can lead to impaired cellular function if prolonged. The document classifies and describes the causes, symptoms, and pathophysiology of different types of shock including hypovolemic, cardiogenic, obstructive, distributive (septic, anaphylactic, neurogenic), and discusses the body's compensatory mechanisms during shock like activation of the sympathetic nervous system and renin-angiotensin system. It outlines the progression from cellular hypoxia to organ dysfunction and failure if shock is not corrected.
Shock is a condition where circulation fails to meet the metabolic needs of tissues due to inadequate oxygen delivery. There are several types of shock based on etiology, including hypovolemic from blood/fluid loss, cardiogenic from heart failure, obstructive from pulmonary embolism, and septic from infection. Signs of shock range from mild with pale skin to severe with unconsciousness. Treatment focuses on restoring tissue perfusion through fluid resuscitation, vasopressors, and inotropes while also treating the underlying cause. The goals of resuscitation are to increase oxygen delivery and decrease oxygen demand through stabilization of vital signs and tissue perfusion markers.
The document discusses shock, including:
1. Circulatory shock occurs when the circulatory system is unable to provide adequate circulation and tissue perfusion, leading to cellular hypoxia and energy deficit.
2. Shock is classified as hypovolemic, cardiogenic, obstructive, or distributive. Hypovolemic shock results from blood or fluid loss while cardiogenic shock stems from heart problems reducing cardiac output.
3. During the reversible phase of hemorrhagic shock, compensatory mechanisms aim to maintain perfusion through vasoconstriction, tachycardia, fluid shifts, and hormonal responses. However, irreversible shock leads to organ dysfunction and failure without rapid intervention.
This document discusses shock, including its definition, pathophysiology, types, stages, and effects on body systems. Shock is defined as a failure of the circulatory system to maintain adequate organ perfusion. The main types are hypovolemic, cardiogenic, and distributive shock. The stages include initial, nonprogressive, progressive, and refractory. Effects include tissue hypoxia, acid-base imbalances, coagulopathies, and end-organ damage. General signs are tachypnea, tachycardia, hypotension, altered mental status, and oliguria. Early goal-directed resuscitation is important to prevent progression to irreversible shock.
1. Shock is defined as inadequate tissue perfusion to meet metabolic demand and can be caused by hypovolemia, cardiac dysfunction, obstruction of blood flow, or inappropriate blood vessel dilation.
2. Clinical signs of shock include tachycardia, abnormal capillary refill time, weak pulses, hypotension, and altered mental status.
3. Management of shock involves optimizing oxygen delivery through fluid resuscitation, antibiotics, vasopressors, ventilation, and treating the underlying cause to increase blood pressure and tissue perfusion.
This document discusses shock, which is a profound hemodynamic and metabolic disturbance characterized by failure of the circulatory system to maintain adequate organ perfusion. There are four main types of shock: cardiogenic, hypovolemic, distributive, and obstructive. The document outlines the etiology, pathophysiology, clinical presentation, diagnostic evaluation, and management of each type of shock. It emphasizes the importance of early goal-directed therapy and treatment of the underlying cause of shock to increase cardiac output and tissue perfusion in order to prevent multiple organ dysfunction.
Cardiogenic shock is defined as inadequate tissue perfusion due to cardiac dysfunction or hypo-perfusion of end organs due to cardiac failure. It has a high mortality rate of 50-80% and is most commonly caused by extensive acute myocardial infarction. Symptoms include cyanosis, decreased consciousness, and low blood pressure. Diagnosis involves identifying hypotension, low cardiac index, and signs of hypoperfusion on physical exam along with supportive tests like EKG, echocardiogram, and Swan-Ganz catheter. Treatment focuses on optimizing prefusion with vasopressors or inotropes, diuretics, emergent revascularization through cardiac catheterization, and mechanical circulatory support like IABP,
This document discusses different types of hemorrhage and shock, including:
1) Types of hemorrhage include external, internal, traumatic, and non-traumatic bleeding from various locations in the body.
2) Shock is classified as hypovolemic, cardiogenic, vasogenic, neurogenic, or mixed. Compensated shock involves tachycardia and anxiety while decompensated shock includes confusion and low blood pressure.
3) General management of shock includes maintaining an open airway, high oxygen, IV access, monitoring vitals, and controlling bleeding for hypovolemic shock. Fluid resuscitation is important but type and amount depends on shock classification.
This document provides information on shock, including its definition, physiology, pathophysiology, types, symptoms, signs, management, and treatment. It defines shock as inadequate perfusion leading to inadequate oxygen delivery to tissues. The stages of shock are described as initial, compensatory, progressive, and irreversible. Types of shock include cardiogenic, hypovolemic, neurogenic, septic, anaphylactic, and obstructive shock. Signs and symptoms result from cellular hypoperfusion and include restlessness, tachycardia, decreased consciousness, nausea, and decreased urine output. Management involves treating the underlying cause, giving oxygen, intravenous fluids, and vasopressors if needed. The goal of treatment is
This document defines shock and outlines its causes, consequences, diagnosis, and management. Shock is defined as reduced effective tissue perfusion leading to cellular and circulatory dysfunction. The main types of shock discussed are hypovolemic, cardiogenic, distributive, and obstructive shock. The consequences of shock include anaerobic metabolism, lactic acidosis, and ultimately organ dysfunction or failure if not treated. Diagnosis involves assessing for signs of hypoperfusion like decreased mental status and oliguria. Management focuses on restoring perfusion through fluid resuscitation and treating the underlying cause.
This document provides an overview of shock, including its classification, pathophysiology, stages, diagnostic studies, and collaborative care. Shock is defined as a syndrome characterized by decreased tissue perfusion and cellular metabolism due to an imbalance in oxygen supply and demand. The main types of shock discussed are cardiogenic, hypovolemic, neurogenic, anaphylactic, and septic shock. The stages of shock progression from initial to refractory are also outlined. Key aspects of shock management include identifying the cause, restoring perfusion through fluid resuscitation and vasoactive drugs if needed, and supporting failing organs.
Shock is a state of low tissue perfusion that can lead to cell death if not treated promptly. There are several types of shock including hypovolemic, cardiogenic, obstructive, distributive, and endocrine. The management of shock involves identifying the underlying cause, restoring adequate perfusion and oxygen delivery, and providing supportive care. Initial treatment consists of oxygen, IV fluids, and medications to support blood pressure and organ function while the root cause is addressed. Prompt recognition and treatment of shock is crucial to prevent organ damage and death.
This document discusses the identification and treatment of various types of shock states. It defines hypovolemic, distributive, cardiogenic, and septic shock and their clinical manifestations. Early diagnosis is key, involving history, physical exam assessing vital signs, perfusion, and urinary output. Treatment focuses on establishing airway, supplying oxygen, restoring circulating volume with fluids, and using vasopressors to improve cardiac output as needed based on the type and severity of shock. Children in particular can maintain blood pressure while showing signs of poor peripheral perfusion.
The document discusses different types of shock including cardiogenic shock, hypovolemic shock, and distributive shock. Cardiogenic shock is defined as inadequate pumping of the heart due to cardiac dysfunction or obstruction. It commonly occurs after myocardial infarction and has a high mortality rate. Hypovolemic shock results from inadequate circulating blood volume due to blood or fluid loss. Both types of shock can lead to organ dysfunction if not treated promptly with fluid resuscitation, vasopressors, and other supportive measures. The document provides details on the pathophysiology, clinical manifestations, diagnostic evaluation, and management of cardiogenic and hypovolemic shock.
The post-operative patient needs management of various issues including pain, delirium, respiratory compromise, cardiovascular issues, and infection. Major post-op issues stem from the body's stress response to surgery, including systemic inflammation, catabolism, insulin resistance, and fluid/electrolyte changes. Care requires monitoring for signs of organ dysfunction and providing support for individual organ systems while addressing surgery-specific concerns.
(5) nursing care plans (ncp) for cardiogenic shockMustafa Abdalla
The document provides information on cardiogenic shock, including its causes and nursing care plans. Cardiogenic shock is caused by the heart's inability to pump sufficiently due to impaired contractility. It is usually associated with conditions like myocardial infarction.
The nursing care plans for cardiogenic shock involve careful assessment, monitoring of vital signs and fluid status, and adjusting medications based on assessments. Five specific nursing care plans are outlined covering impaired gas exchange, decreased cardiac output, ineffective tissue perfusion, excess fluid volume, and anxiety. The plans describe potential signs and symptoms, desired outcomes, and nursing interventions with rationales.
This document provides an overview of neonatal shock and hypotension. It defines shock, discusses the pathophysiology including factors that influence cardiac output and blood flow to tissues. It describes the stages of shock, risk factors, clinical manifestations, evaluation and treatment including volume expanders and vasoactive drugs. Specific types of shock like hypovolemic, cardiogenic, distributive and their treatments are explained. Intractable shock and further care are also summarized.
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5. The degree of shock depends on
Blood loss
Rate at which it was lost
Patient’s ability to activate compensatory
mechanisms
Age
Physical condition
Hypothermia
Pain
6. Organs Involved in Response to
Shock
Brain: brainstem, hypothalamus,
autonomic nervous system
Heart and blood vessels
Kidney
Adrenal Gland
Lungs
7. Three causes of non-septic shock
Hypovolaemia
Neurogenic
Cardiogenic
8. Hypovolaemia
Due to intravascular fluid loss
Causes Haemorrhage (external/internal)
Fractures
Burns
Dehydration (especially children and the
elderly)
9. Cardiogenic
Due to pump failure
Causes Myocardial Infarction
Heart surgery
Pulmonary Embolism
Cardiac Tamponade
Tension Pneumothorax
10. Neurogenic
Due to loss of vasomotor control, leading
to alteration in vessel tone and size which
results in general vasodilation.
Causes Severe brain stem injury
High spinal injury resulting in
damage to sympathetic nervous
system
13. Baroreceptors reduce
vagal tone and
enhances
sympathetic response
Increases heart rate
and enhances
myocardial contractility
Vasoconstriction
occurs – results
in increased
peripheral resistance
Cardiovascular
14. Signs
Decreased colour/warmth of periphery
Increased respirations
Increased heart rate
Blood pressure will not drop until
vasoconstriction and pulse rate has failed
to compensate adequately – usually when
30% of circulating blood volume has been
lost.
15. Renal
Baroreceptors identify
fall in BP
Hypothalamus controls
release of ADH
Water is
re-absorbed
from kidney’s
distal tubules
Conserves
intravascular volume
16. Renin released
by juxtaglomerular
apparatus
Angiotensin produced
Angiotensin I converted
to
Angiotensin II
Stimulates release
of aldosterone
Aldosterone and ADH
promote re-absorption
of sodium & chloride &
excretion of potassium
Increases the
re-absorption of water
– increases blood
volume
18. Respiratory
Chemoreceptors in the carotid body detect
CO2 in hypoxic tissue and the build-up of
lactic acid.
Stimulates the respiratory centre in the
medulla oblongata
Increases the respiratory rate and depth:
to excrete CO2
to maximise oxygenation of red blood
cells
19. Cerebral
Reduction in MAP and CPP causes
autoregulation to fail
This reduction in cerebral blood flow:
- reduces O2 delivery to the brain
- reduces removal of CO2
Results in decreasing level of
consciousness
23. Classification of shock
Estimated blood loss and critical measures (based on 70kg male)
Class I Class II Class III Class IV
Blood loss (mL) Up to 750 750-1500 1500-2000 >2000
Blood loss (%
blood
volume)
Up to 15% 15-30% 30-40% >40%
Pulse rate <100 100-120 120-140 >140
Blood pressure Normal Normal Decreased Decreased
Pulse pressure
(mm Hg)
Normal or
increase
d
Decreased Decreased Decreased
Respiratory
rate
14-20 20-30 30-40 >35
Urine
output(m
L/hr)
> 30 20-30 5-15 Negligible
CNS/mental
status
Slightly
anxious
Mildly
anxious
Anxious,
confused
Confused,
lethargic
Fluid
replaceme
nt
Crystalloid Crystalloid Crystalloid
and
blood
Crystalloid
and
blood
24. Fluid Resuscitation
Electrolyte solutions – 0.9% Normal Saline
Hartmans
1-2 litres initial bolus of warmed fluid
20mL/kg in children
If observations do not improve, assume
that circulating volume is being lost faster
than it can be replaced
Definitive control of haemorrhage is
required
25. Responses to Initial Fluid Resuscitation *
RAPID
RESPONSE
TRANSIENT
RESPONSE
MINIMAL OR
NO RESPONSE
VITAL SIGNS Return to normal Transient
improvement:
recurrence of
decreased BP and
increased HR
Remain abnormal
ESTIMATED
BLOOD LOSS
Minimal (10-20%) Moderate and
ongoing (20-40%)
Severe (> 40%)
NEED FOR
MORE
CRYSTALLOID
Low High High
NEED FOR
BLOOD
Low Moderate to high Immediate
BLOOD
PREPARATION
Type and
crossmatch
Type-specific Emergency blood
release (MHP)
NEED FOR
OPERATIVE
INTERVENTION
Possibly Likely Highly likely
EARLY
PRESENCE OF
SURGEON
Yes Yes Yes
*2000ml of crystalloid in adults; 20mL/kg bolus in children
26. Major Haemorrhage Procedure
Estimated blood loss > 30% of circulating
volume with ongoing bleeding or
haemorrhagic shock
Systolic BP <70mmHg, or <90mmHg after
fluid challenge, with suspected
haemorrhagic cause
27. 2222
Major haemorrhage in A&E,
I am activating the MHP
Send bloods to lab
Order MHP 1
Red cells 4 units
FFP 4 units
O neg can be used in meantime
MHP1 available in 25 mins
Give MHP 1
Re-assess
Stop the bleeding
Haemorrhage control
and
Haemostatic drugs
MHP 2
Red cells 4 units
FFP 4 units
Platelets 1 dose
Cryoprecipitate 2 packs
28. Stop the Bleeding
Haemorrhage Control
Stabilise #’s – pelvic binder
straighten/splint femur
Surgical Intervention
Celox
29. Stop the Bleeding
Haemostatic Drugs
Tranexamic acid – 1g in100mL N.Saline
over 10mins
followed by 1g in 500mL N.Saline
over 8 hours
30. How it works!
Fibrinolysis – a normal body process
preventing the formation/growth of blood
clots.
Plasminogen released from the liver, has
an affinity for fibrin & is incorporated into a
blood clot when it is formed.
Converts to plasmin, an enzyme that
dissolves the fibrin clot.
31. Fibronlysis is an important contributor to
bleeding and coagulopathy in trauma.
Tranexamic acid inhibits fibrinloysis.
CRASH-2 authors report a 32% reduction
in bleeding when tranexamic acid is given
within 1 hour of injury.
33. Elderly
Mortality and morbidity rates increase
directly with age.
Slower blood circulation
Decreased lung volume and compliance
Decreased cardiac function
Slower metabolic rate
Decreased vasoconstrictor response
More likely to be chronically dehydrated
34. Athletes
Blood volume may increase by 15-20 %
Stroke volume increase by 50%
Resting HR can average 50bpm
Ability to compensate for blood loss
Usual responses to hypovolaemia may not
be evident, even when significant blood
loss has occurred
35. Pregnancy
Increased intravascular volume
Uterine compression of the vena cava may
reduce venous return to the heart
Priority is always the mother
Obstetrics should be called as part of the
trauma team
36. Cellular
Blood acidity increases Toxicity increases Tissue necrosis
Death of organ
Cell ruptures and
releases toxins
Multiple organ failure
38. Renal
Continuing reduced urine output occurs
Patient becomes anuric
Kidney fails
Renal tubules become ischaemic and
necrotic
Acute tubular necrosis of the kidney may
lead to acute renal failure.
Contributes to the 3rd peak of death
following trauma.
39. Respiratory
Ventilation and /or perfusion and gas
exchange does not take place resulting in
Atelectasis
Adult Respiratory Distress Syndrome
Respiratory muscle fatigue
Respiratory failure
Respiratory failure is one of the primary causes of death
following initial successful resuscitation of trauma
40. Cerebral
Mean Arterial Pressure drops below 50-
70mm HG, level of consciousness is
reduced
Unconsciousness occurs when less than
50% of the blood volume is in the
circulation
Brain becomes ischaemic
Irreversible brain injury occurs.
41. If shock is not treated adequately,
irreversible shock will occur
Death is inevitable