This document provides an overview of the principles of shock management. It defines shock and describes its causes, including hypovolemic, cardiogenic, obstructive, distributive, and endocrine shock. The pathophysiology of shock is explained at the cellular, microvascular, and systemic levels. The stages of shock - non-progressive, progressive decompensated, and decompensated - are outlined. Signs and symptoms of shock are provided. Finally, the document discusses the general management of shock, which aims to improve oxygen delivery and utilization to prevent organ injury through restoration of perfusion and supportive care.
With the pandemic overclouding the whole world it has effected every strato of people including the Orthopaedic groups. This is to highlight the impact of COVID 19 on the orthopaedic in general.
Conservative management in 3 and 4 part proximal humerus fractureBipulBorthakur
Proximal humerus fracture is common in both young as well as elderly people with most of the elderly patients unable to undergo operative management. This study is to see the aspect of conservative management in proximal humerus fracture.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
3. DEFINITION
Shock is a systemic state of low tissue perfusion that is
inadequate for normal cellular respiration.
With insufficient delivery of oxygen and glucose, cells switch
from aerobic to anaerobic metabolism.
If perfusion is not restored in a timely fashion, cell death
ensues.
The end result is hypotension and cellular hypoxia and, if
uncompensated, may lead to impaired cellular metabolism and
death.
4. Shock is the most common and therefore the
most important cause of death of surgical
patients.
Death may occur rapidly due to profound state
of shock, or be delayed due to consequences of
organ ischaemia and reperfusion injury.
5. CLASSIFICATION OF
SHOCK
Classification of shock on the basis of
initiating mechanism:
Hypovolaemic shock
Cardiogenic shock
Obstructive shock
Distributive shock
Endocrine shock
6.
7. 1 HYPOVOLAEMIC SHOCK
Hypovolaemic shock is due to a reduced circulating volume.
Hypovolaemia may be due to haemorrhagic or non-haemorrhagic
causes.
Haemorrhagic causes :
Trauma
Surgery
Non-haemorrhagic causes:
poor fluid intake (dehydration)
excessive fluid loss due to vomiting, diarrhoea, urinary loss
‘third-spacing’ where fluid is lost into the gastrointestinal tract
and interstitial spaces
10. CARDIOGENIC SHOCK
Cardiogenic shock is due to primary failure of
the heart to pump blood to the tissues.
Causes of Cardiogenic shock include:
- Myocardial infarction
- Cardiac arrhythmia
- Valvular heart disease
- Myocardial injury
- Cardiomyopathy
11. OBSTRUCTIVE SHOCK:
In obstructive shock there is a reduction in preload due
to mechanical obstruction of cardiac filling.
Common causes of obstructive shock include;
- Cardiac tamponade
- Tension pneumothorax
- Massive pulmonary embolus or Air embolus
In each case, there is reduced filling of the left and/or
right sides of the heart leading to reduced preload and a
fall in cardiac output.
12. DISTRIBUTIVE SHOCK
Distributive shock describes the pattern of
cardiovascular responses characterising a variety of
conditions including;
A) Septic shock
B) Anaphylactic shock
C) Spinal cord injury (Neurogenic shock).
13. A) SEPTIC SHOCK
It is related to the release of bacterial products
(endotoxin) and the activation of cellular and humoral
components of the immune system.
There is maldistribution of blood flow at a
microvascular level
Arteriovenous shunting
Dysfunction of cellular utilization of oxygen.
In the later phases of septic shock there is
hypovolaemia from fluid loss into interstitial spaces and
there may be concomitant myocardial depression.
16. B) ANAPHYLACTIC SHOCK
• It is a type of severe hypersensitivity or allergic reaction.
• Causes include allergy to insect stings, medicines or foods (Nuts,
Berries, Sea foods) etc.
• It is caused by a severe reaction to an allergen, leading to the
release of histamine that causes widespread vasodilation and
hypotension.
17. C) NEUROGENIC SHOCK
It is caused by spinal cord injury usually as a
result of a traumatic injury or accident.
There is failure of sympathetic outflow and
adequate vascular tone.
Damage to CNS impairs cardiac function by
reducing heart rate and loosening the blood
vessel tone resulting in severe hypotension.
19. A) CELLULAR LEVEL
As perfusion to the tissues is reduced, cells are deprived
of oxygen and must switch from aerobic to anaerobic
metabolism.
The product OF anaerobic metabolism lactic acid.
the accumulation of lactic acid in the blood produces
systemic metabolic acidosis.
There is failure of the sodium/potassium pumps.
Intracellular lysosomes release autodigestive enzymes
and cell lysis ensues.
Intracellular contents, including potassium, are released
into the bloodstream.
20. B) MICROVASCULAR LEVEL
Activation of the immune and coagulation
systems.
Generation of oxygen free radicals and
cytokine release.
These mechanisms lead to injury of the
capillary endothelial cells. These, in turn,
further activate the immune and coagulation
system.
21. C) SYSTEMIC LEVEL
1) CARDIOVASCULAR:
As preload and afterload decrease, there is a
compensatory baroreceptor response
resulting in increased sympathetic activity and
release of catecholamines into the circulation.
This results in tachycardia and systemic
vasoconstriction
22. 2) RESPIRATORY SYSTEM:
Metabolic acidosis and sympathetic response result in an increased
respiratory rate
Increased minute ventilation lead to increase the excretion of carbon
dioxide.
It produce a compensatory respiratory alkalosis.
23. 3) RENAL
Increased afferent arteriolar resistance accounts for
diminished glomerular filtration rate (GFR)
Increased aldosterone and vasopressin, is responsible for
reduced urine formation.
Reduced filtration at the glomerulus and a decreased urine
output.
The stimulated renin–angiotensin–aldosterone system
resulting in further vasoconstriction and increased sodium and
water reabsorption by the kidney.
24. 4)ENDOCRINE
Vasopressin (antidiuretic hormone) is released from
the hypothalamus in response to decreased preload
and results in vasoconstriction.
Cortisol is released from the adrenal cortex,
contributing to the sodium and water resorption and
sensitising cells to catecholamines.
25. 5) METABOLIC
There is disruption of the normal cycles of
carbohydrate, lipid, and protein metabolism.
Aalanine in conjunction with lactate enhances the
hepatic production of glucose.
With reduced availability of oxygen, the breakdown of
glucose to pyruvate, and ultimately lactate, represents
an inefficient cycling with minimal net energy
production.
26. SEQUENTIAL EVENTS IN THE
MECHANISM OF SHOCK:
Decreased effective circulating blood volume.
Decreased venous return to the heart.
Decreased cardiac output.
Decreased blood flow.
Decreased supply of oxygen.
Anoxia.
Shock.
28. CAPILLARY REFILL:
Most patients in hypovolemic shock will have
cool, pale peripheries, with prolonged capillary
refill times.
This is not a specific marker of whether a
patient is in shock.
In septic shock, the periphery will be warm and
capillary refill will be brisk, despite profound
shock.
29. TACHYCARDIA:
Tachycardia may not always accompany shock.
Patients who are on beta-blockers or who have
implanted pacemakers are unable to mount a
tachycardia.
In young patients, with penetrating trauma
where there is hemorrhage but little tissue
damage, there may be a paradoxical
bradycardia rather than tachycardia.
30. BLOOD PRESSURE:
Hypotension is one of the last signs of shock
Children and young adults are able to maintain
BP until the final stages of shock by increasing
stroke volume and peripheral vasoconstriction.
These patients can be in profound shock with a
normal blood pressure.
32. 1NON-PROGRESSIVE STAGE OF SHOCK:
In the early stage of shock, an attempt is made to maintain adequate
cerebral and coronary blood supply by redistribution of blood.
If the cause are adequately treated, the compensatory mechanism may be
able to bring about recovery & re-establish the normal circulation; this is
called compensated or reversible shock.
These Compensatory mechanisms are:
i) Wide spread vasoconstriction
ii) Fluid conservation by the kidney
iii) Vascular autoregulation
33. PROGRESSIVE DECOMPENSATED
SHOCK:
This is a stage when the patient suffers from Risk factors (e.g.
Pre-existing cardiovascular and lung disease) besides
persistence of the shock so that there is a progressive
deterioration.
The effects of progressive decompensated shock are:
a) Pulmonary hypoperfusion with resultant tachypnoea and
ARDS.
b) Anaerobic glycolysis resulting in Metabolic acidosis.
34. DECOMPENSATED (IRREVERSIBLE)
SHOCK:
When the shock is so severe that inspite of compensatory mechanisms, no
recovery takes place, it is called decompensated or irreversible shock.
Effects due to widespread cell injury include:
a) Deterioration in cardiac output.
b) Severe metabolic acidosis
c) Pulmonary oedema, tachypnoea and ARDS
d) Ischemic cell death of brain, heart and kidneys due to reduced blood
supply to these organs.
Clinically the patient has features of coma, worsened heart function and
progressive renal failure.
35. MANAGEMENT OF SHOCK:
General principles of shock management:
1. The overall goal of shock management is to improve
oxygen delivery/utilisation in order to prevent cellular
and organ injury.
2. Effective therapy requires treatment of underlying
etiology.
3. Restoration of adequate perfusion, monitoring and
comprehensive supportive care.
4. Interventions to restore perfusion centre, increasing
cardiac output and optimising oxygen content.
5. Oxygen demand should also be reduced.
36. PHYSICAL EXAMINATION:
Increased HR
Tachypnea
Mean arterial pressure less than 60 mmHg (not
always present)
Confusion and encephalopathy
Oliguria
Decreased capillary refill and cold skin.
37. PHYSICAL EXAMINATION:
Site of an untreated infection
GI Hemorrhage on rectal examination.
Pulsus paradox and elevated JVP seen in
cardiac tamponade
Paucity of breath sounds, deviation of trachea
away from the affected side, subcutaneous
emphysema seen in tension pneumothorax
38. DIAGNOSTIC TESTING:
The laboratory evaluation is directed toward the dual aim of assessing the
extent of end organ dysfunction and of gaining insight into the possible
etiology of shock.
39. DIAGNOSTIC TESTING:
BLOOD TESTS:
Blood urea nitrogen (BUN), creatinine, transaminase
evaluation show extent of end organ damage
Urine electrolytes, FE Na, FE urea indicate hypovolemia
status
Increased WBCs show infective process
Increased cardiac enzymes show primary cardiac problem
Blood cultures, urine cultures and sputum cultures should be
obtained.
Lactate measurement
41. MONITORING:
Echocardiography: an echocardiogram should be
obtained in patients with suspected cardiogenic shock.
Advanced hemodynamic monitoring: recently new
central venous catheter systems linked with computer
based algorithms provides continuous monitoring of
hemodynamic parameters.
Cardiac catheterization and coronary angiography
indicated in all patients with cardiogenic shock.
42. SYSTEMIC AND ORGAN
PERFUSION:
The best measure of organ perfusion and the best monitor
of adequacy of shock therapy remains the urine output.
43. RESUSCITATION:
Resuscitation should not be delayed in order to
definitively diagnose the source of the shocked state.
If there is initial doubt of cause of shock, it is safer to
assume the cause is hypovolemia. And begin fluid
resuscitation.
Intravenous fluids should be given through short, wide
bore catheters.
The oxygen carrying capacity of crystalloid and colloids
is zero
If blood is being lost, the ideal replacement is blood,
although crystalloid therapy may be required while
awaiting blood products.
44. VASOPRESSOR AND INOTROPIC
SUPPORT:
Vasopressor agents (phenylephrine,
noradrenaline) are indicated in distributive
shock.
When vasodilation is resistant to
catecholamines, vasopressin may be used as
an alternative vasopressor.
In cardiogenic shock, inotropic therapy
required to increase cardiac output, dobutamine
is the agent of choice.
45. END POINTS OF
RESUSCITATION:
Traditionally, patients have been resuscitated until they
have a normal pulse, BP, and urine output.
Occult hypoperfusion: state of normal vital signs and
continued underperfusion.
With current monitoring techniques, occult
hypoperfusion is manifested only by a persistent lactic
acidosis and low mixed venous oxygen saturation.
Resuscitation algorithms directed at correcting global
perfusion end points ( base deficits, lactate, mixed
venous oxygen saturation ) rather than traditional end
points have been shown to improve mortality and
morbidity in high risk surgical patients.
46. MANAGEMENT OF
HYPOVOLAEMIC SHOCK:
• Maximise oxygen delivery-completed by ensuring
adequacy of ventilation
• Control further blood loss.
• Fluid resuscitation.
50. MANAGEMENT OF SEPTIC
SHOCK:
General Supportive Care :
Patients requiring a vasopressor should have an arterial catheter placed
as soon as is practical.
Hydrocortisone is not suggested in septic shock.
Continuous or intermittent sedation should be minimized in
mechanically ventilated sepsis patients.
A protocol-based approach to blood glucose management should be
used in ICU patients with sepsis, with insulin dosing initiated when two
Consecutive blood glucose levels are >180 mg/dL.
Continuous or intermittent renal replacement therapy should be used in
patients with sepsis and acute kidney injury.
Stress ulcer prophylaxis should be given to patients with risk factors
for gastrointestinal bleeding.
51. MANAGEMENT OF NEUROGENIC
SHOCK:
Immobilization: if the patient has a suspected case of spinal cord
injury.
High dose steroid to reduce inflammation
IV fluids: administration of IV fluids is done to stabilize the patient’s
blood pressure.
Inotropic agents such as dopamine may be infused for fluid
resuscitation.
Atropine is given intravenously to manage severe bradycardia.
52. MANAGEMENT OF CARDIOGENIC
SHOCK:
Management of Cardiogenic shock includes supportive measures which
includes:
Oxygen therapy
Judicious use of fluids with careful monitoring of central venous pressure
or pulmonary wedge pressure.
Other monitoring include continuous ECG, 12 lead ECG, urine output,
urea and electrolytes & blood gases.
Patient should be preferably managed in coronary care unit.
Drugs like morphine 5-10mg IV helps to relieve pain and anxiety
associated with myocardial infarction.
Inotropic support, vasodilators and mechanical support may be needed.
53. MANAGEMENT OF ANAPHYLACTIC
SHOCK:
During an anaphylactic attack, cardiopulmonary
resuscitation (CPR) may be needed if breathing or heart
beat is stopped.
Medications in Anaphylactic shock includes:
1. Epinephrine (adrenaline) to reduce body’s allergic
response.
2. Oxygen, which helps in breathing.
3. Intravenous anti histaminics and cortisone to reduce
inflammation of air passages and improve breathing.
4. Beta agonist (e.g. Albuterol) to relieve breathing
symptoms.