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power point presentation on shock management.pptx
- 2. Definition & mechanism of shock. Consequences of Shock. How to diagnose shock? Classification of Shock. Causes of various types of shock Basic principles in management of shock.
- 3. Shock is reduction of effective tissue perfusion leading to cellular and circulatory dysfunction It is a medical emergency, if unrecognized or inadequately treated will result in high mortality
- 5. The aim of perfusion is to achieve adequate Cellular Oxygenation This requires Red Cell Red Cell Oxygenation Delivery To Tissues
- 6. Red Cell Oxygenation 1. Oxygen delivery to alveoli Adequate FiO2 Patent airways Adequate ventilation
- 7. 2. Oxygen exchange with blood Adequate oxygen diffusion into blood Adequate RBC capacity to bind O2 pH Temperature
- 8. Red Cell Delivery To Tissues 1. Adequate perfusion Blood volume Cardiac output Heart rate Stroke volume Conductance Arterial resistance Venous capacitance
- 9. 2. Adequate Hgb Adequate Hgb levels Adequate RBC capacity to bind O2 pH Temperature
- 10. Inadequate tissue perfusion: Poor cellular Shift from aerobic Oxygenation to anaerobic metabolism
- 11. GLUCOSE METABOLISM 2 LACTIC ACID 2 ATP HEAT (32 kcal) Glycolysis: Inefficient source of energy production; 2 ATP for every glucose; produces pyruvic acid
- 12. 6 O2 GLUCOSE METABOLISM 6 CO2 6 H2O 36 ATP HEAT (417 kcal) Oxidative phosphorylation: Each pyruvic acid is converted into 34 ATP
- 13. Occurs without oxygen ◦ oxidative phosphorylation can’t occur without oxygen ◦ glycolysis can occur without oxygen ◦ cellular death leads to tissue and organ death ◦ can occur even after return of perfusion organ dysfunction or death
- 15. Markers Of Hypo perfusion ◦ ↑ Serum Lactate ◦ Metabolic acidosis ◦ Hypotension
- 16. Adequate Volume Normal Cardiac Function Normal Vessels Failure of one or more of these causes shock
- 17. Hypovolemic Shock - Blood volume problem Cardiogenic Shock - Blood pump problem Obstructive Shock - Filling Problem Distributive Shock - Blood vessels problem
- 18. Loss of Volume Blood loss ▪ Trauma ▪ Non-traumatic Vaginal GI GU Fluid loss - Dehydration - Burns - Diarrhea - Vomiting - Diuresis - Sweating Third space losses Pancreatitis Peritonitis Bowel obstruction
- 20. Recognize & Treat during compensatory phase Restlessness, anxiety, combativeness = Earliest signs of shock Best indicator of resuscitation effectiveness = Level of Consciousness
- 21. Tissue ischemic sensitivity ◦ Heart, brain, lung: 4 to 6 minutes ◦ GI tract, liver, kidney: 45 to 60 minutes ◦ Muscle, skin: 2 to 3 hours Resuscitate Critical Tissues First
- 22. Goal: Restore circulating volume, tissue perfusion & correct cause A B C Two large bore IV lines/central line Fluids / Blood & Products /vasopressors Target arterial BP – SBP ≥ 90 mmHg - MAP ≥65 mmHg. Catheterize the bladder IV Cannulation
- 23. Consequences of volume loss 15%[750ml]- compensatory mechanism maintains cardiac output 15-30% [750-1500ml]-decreased BP & urine output 30-40% [1500-2000ml] -profound shock along with severe acidosis 40-50% - refractory stage
- 24. Cardiogenic Shock = Pump Failure Myopathic -M I -CHF -Cardiomyopathy Arrhythmic -Tachy or bradyarrhythmias Mechanical -Valvular Failure
- 25. History Chest pain, Palpitations, SOB RHD, IHD Physical exam Signs of ventricular failure Heart : Murmurs,S3,S4
- 26. Treat rate, then rhythm, then BP Correct bradycardia or tachycardia Correct irregular rhythms Treat BP ↑Cardiac contractility (inotropes) Dobutamine, Dopamine
- 27. Inadequate perfusion of tissues due to mal- distribution of blood flow (blood vessels problem) Cardiac pump & blood volume are normal but blood is not reaching the tissues.
- 28. Septic Shock Anaphylactic Shock Neurogenic/Vasogenic (spinal cord)
- 29. Septic shock is the most common cause of distributive shock and is caused by an overwhelming systemic infection that cannot be cleared by the immune system, resulting in vasodilation and hypotension
- 30. A B C Assist ventilation & Augment Oxygenation Restore Tissue perfusion- IV Fluids, Vasopressors Identification & Eradication of septic foci Specific therapies (antibiotics)
- 31. Anaphylactic shock is caused by a severe reaction to an allergen, leading to the release of histamine that causes widespread vasodilation and hypotension. In Anaphylaxis blood pressure drops suddenly and the airways narrow, blocking breathing. Signs and symptoms include a rapid, weak pulse; a skin rash; and nausea and vomiting. Common triggers include certain foods, some medications, insect venom and latex.
- 32. Epinephrine (adrenaline) to reduce the body's allergic response. Oxygen, to help breathe. Intravenous (IV) antihistamines and cortisone to reduce inflammation of the air passages and improve breathing. A beta-agonist (such as albuterol) to relieve breathing symptoms. Isotonic Fluids
- 33. Neurogenic shock arises due to damage to the central nervous system, which impairs cardiac function by reducing heart rate and loosening the blood vessel tone, resulting in severe hypotension
- 34. Patient supine; lower extremities elevated Avoid Trendelenburg Infuse isotonic crystalloid Maintain body temperature
- 35. Obstructive shock is a condition that prevents blood and oxygen from getting to organs Something is obstructing or getting in the way of blood going into and out of the heart or great vessels Lead to drop in blood pressure and the amount of blood the heart is able to pump
- 36. Impaired cardiac filling Cardiac tamponade Constrictive pericarditis Tension pneumothorax Increased ventricular afterload Pulmonary embolism
- 37. ◦ Control airway Intubation ◦ Treat the underlying cause Tension Pneumothorax: Chest tube Pericardial Tamponade: Pericardiocentesis Pulmonary Embolism: Anticoagulation ◦ Isotonic fluids
- 38. Falling BP = late sign of shock. BP is not same thing as perfusion. Pallor, tachycardia, slow capillary refill = hypo perfusion, until proven otherwise.
- 39. Avoid vasopressors until hypovolemia ruled out, or corrected Squeezing partially empty tank can cause ischemia, necrosis of kidney and bowel