Shock

1. Bondarenko A.V.
General issues of diagnosis
and treatment of polytraumas.
Shock, blood loss, transfusion
therapy for polytrauma.
Barnaul, January 2005
Translated from Russian to English - www.onlinedoctranslator.com

2. Distribution of mortality in cases of
considered injuries by timing and main
causes
Mortality Main reasons % %
Immediate
(seconds, minutes)
Damage to large vessels of the
chest and abdomen, brain
damage
50%
Nearest
(within 6 hours)
Chest trauma, ruptures of the
liver, spleen, multiple fractures
30-35%
Late
(more than 6 hours
from the moment of
injury)
Pneumonia, sepsis, MODS, PE,
etc.
15-20%

3. SHOCKis a state of
inadequate tissue perfusion
and oxygenation with
subsequent metabolic
disorders and cell death.

4. Stages of shock (Wiggers,
1950)
I.Stage of development
II.Compensation stage
III.Stage of decompensation
IV.Irreversible stage

5. Shock indexAllgower
pulse
HELL
 1 (
60
120 = 0.5 = normal)

6. Shock classification
1. Hypovolemic shock
2. Cardiogenic shock
3. Obstructive shock
4. Distributive shock

7. Hypovolemic shock
• Hemorrhagic– trauma, gastrointestinal7e
bleeding, ruptured aneurysms, etc.
• Nonhemorrhagic– dehydration: vomiting,
diarrhea, burns, polyuria, etc.

8. Cardiogenic shock
• Decreased cardiac output due to myocardial
damage –heart attack, contusion, myocarditis,
myocardial depression caused by endotoxemia
(sepsis, acidosis, hypoxia), etc.
• Reduced cardiac output caused by anatomical
defects of the heart -valve stenosis, septal
defect, etc.

9. Obstructive shock
• External compression of the heart and
large vessels –tension pneumothorax,
pericarditis, hemopericardium, mediastinal
tumors, etc.
• Obstruction of the vascular bed –
pulmonary embolism, etc.

10. Distributive shock
 Systemic inflammatory response syndrome –
sepsis, pancreatitis, trauma, burns.
 Anaphylactic, anaphylactoid reactions.
 Neurogenic pathology– spinal injury.
 Medicines– vasodilators.
 Pathology of the endocrine system– myxedema,
adrenal insufficiency.

11. Diagnosis of shock
(hypotension, metabolic acidosis,
multiple organ failure)
1. Brain– impaired cerebral perfusion, drowsiness, confusion, coma.
2. Heart– decreased stroke volume, myocardial ischemia, pulmonary
edema.
3. Kidneys– oliguria, anuria.
4. Liver– increased levels of isoenzymes, hyperglycemia,
hyperbilirubinemia.
5. Leather- pallor, sweating, cyanosis.
6. Blood coagulation system -hypercoagulation, disseminated
intravascular coagulation.
7. Thermoregulation system –hypothermia.

12. Shock therapy
 Stop bleeding
 Oxygen therapy
 Infusion therapy (combination colloids and crystalloids)
 Blood transfusion therapy (Hb >/= 100G/l
 Correction of metabolic acidase, disturbances in potassium
and sodium metabolism
 Inotropic drugs(with the exception of bleeding,
vasodilation, obstructive shock).

13. I.Primary examination for
polytrauma
• A– (Airway)ensuring airway patency
• B – (Breathing)ensuring adequate ventilation and oxygenation
• WITH - (Circulation)stop external bleeding, providing intravenous
access
• D – (Disability)study of neurological abnormalities[vital functions,
state of consciousness, motor reactions, condition and reaction of the
pupils].
• E – (Exposure)examination of a naked patient

14. II.Resuscitation and
monitoring
A. Patient monitoring
B. Bladder catheterization
C. Nasogastric tube
D. X-ray examination

15. III.Secondary assessment of
the patient's condition
A. Head(examination and assessment of coma according to the
Glasgow scale)
B. Maxillofacial region
C. Neck and cervical spine
D. Rib cage(radiography)
E. Stomach(laparocentesis, abdominal ultrasound, CT,
laparoscopy, laparotomy).
F. Crotch
G. Musculoskeletal system(x-ray of the pelvis)
H. Dorsal brain.

16. Thank you
for your attention!