1. Shock is defined as a state of low tissue perfusion resulting from inadequate oxygen and glucose delivery to cells. This causes cells to switch from aerobic to anaerobic metabolism, leading to cell death if not corrected.
2. The pathophysiology of shock involves simultaneous cellular, microvascular, and systemic changes including metabolic acidosis, organ ischemia, immune system activation, and sympathetic nervous system response.
3. Shock is classified based on its underlying cause as hypovolemic, cardiogenic, obstructive, distributive, or endocrine. Resuscitation priorities include addressing hypovolaemia with intravenous fluids before considering further treatment.
The Research topics and reseaech areas has been explained in ail, which are helpful for Undergraduates to get the research grants, PG Scholars and Ph.D Scholars to select theirs research topics..
Agnikarma is parasurgical procedure of ayurveda
The AGNIKARMA, DAHAKARMA, DAHANKARMA, DAGDHAKARMA are intentional therapeutic heat burn therapy used for the treatment of diseases caused by vata and kapha doshas..
Here definitions, indications, contraindications, materials required, methods, dahanopkarana, importance, and superiority of agnikarma are mentioned in detail.
The Research topics and reseaech areas has been explained in ail, which are helpful for Undergraduates to get the research grants, PG Scholars and Ph.D Scholars to select theirs research topics..
Agnikarma is parasurgical procedure of ayurveda
The AGNIKARMA, DAHAKARMA, DAHANKARMA, DAGDHAKARMA are intentional therapeutic heat burn therapy used for the treatment of diseases caused by vata and kapha doshas..
Here definitions, indications, contraindications, materials required, methods, dahanopkarana, importance, and superiority of agnikarma are mentioned in detail.
A Review Article on Different Types of Incisions According to Sushrutaijtsrd
The field of education in medical science is traditionally divided in two branches as one medicine and other surgery. The division wasby the virtue of Agnivesha and Dhanwantarisampradaya exist in Ayurveda from early stage of human civilization.Sushruta is the major scholar of Dhanwantarisampradaaya. Acharya Sushruta laid down the fundamentals of surgery in the very first surgical text in Indian history with all the basic protocols which are still now practiced successfully. Though due to the advancement of medical science, it introduce new technique that completely transformed the practice of surgery over the period of time.Incisions are basics of surgery which has both Surgical and Anatomical importance. Surgical view of incision avoids cosmetic damage and anatomical view provide safeguard to vital structures. Acharya Sushruta stated specific incisions in relation to various parts of bodyas well as in relation to the specific diseases.There are number of incisions explained by Sushruta, like Tiryak, Chandrakara, Ardhacandhrakara, Langalak, Ardhalangalaketc.Hence an attempt made to elaborate different types of incisions told in SushrutaSamhita with their scientific validation. Anjaneya | Syeda Ather Fathima | Shivalingappa J. Arakeri | Mohasin Kadegaon | Geethanjali Hiremath "A Review Article on Different Types of Incisions According to Sushruta" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-6 , October 2021, URL: https://www.ijtsrd.com/papers/ijtsrd47661.pdf Paper URL : https://www.ijtsrd.com/medicine/ayurvedic/47661/a-review-article-on-different-types-of-incisions-according-to-sushruta/anjaneya
Jalaukavacharana - Leech Therapy in AyurvedaDr Adithya J V
Leech Therapy in Ayurveda - A unique modality of treatment in Ayurveda - Insights into Scientific Aspects, Mode of Usage and its scope in treatment of Various Diseases.
Acharya sushruta well known about Importance of Vranashopha stages of abscess formation , Vrana wound and their management in surgical practice. The vranashopha is descrided as earlier phase of vrana. Sushruta has mentioned detail description of inflammatory swelling under the heading of vranashopha. Which has three progressive stages. These are amawastha early stage of inflammatory process , Pachyamanavastha true inflammatory stage respectively. Further Acharya described six types of vranashopha as Vattika, Paittika, shleshmika, Shonita, Sannipattaja, and Agantuja. He described their description according to colour, consistency, Pain, And other symptoms. Acharya sushruta perceived that the process of pathogenesis has a definite sequential pattern distributed over six occasions for treatment called shatkriyakala. Sixty procedures for management of vranashopha inflammatory swelling and vrana abscess was told by sushruta. Out of these first eleven from apatarpana to virechana were mentioned eight procedures were truly for vrana only. It is very important to know all about vranashopha as and treatment in this stage can prevent hazardous complications occur by infected wound. Dr. Chandrakant Budni "Conceptual Review on Vranashopha" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-4 , June 2022, URL: https://www.ijtsrd.com/papers/ijtsrd50114.pdf Paper URL: https://www.ijtsrd.com/medicine/ayurvedic/50114/conceptual-review-on-vranashopha/dr-chandrakant-budni
LN Ayurved College & Hospital, Kolar Road, Bhopal professor of Panchakarma and Head of the department Dr K Shiva Rama Prasad has delivered a Guest lecture on the Importance and Standard procedures of Raktamokshana at Institute of Post Graduate Ayurvedic Education & Research under Dept. of Health & Family Welfare, Government of West Bengal on 18th November 2019.
A Review Article on Different Types of Incisions According to Sushrutaijtsrd
The field of education in medical science is traditionally divided in two branches as one medicine and other surgery. The division wasby the virtue of Agnivesha and Dhanwantarisampradaya exist in Ayurveda from early stage of human civilization.Sushruta is the major scholar of Dhanwantarisampradaaya. Acharya Sushruta laid down the fundamentals of surgery in the very first surgical text in Indian history with all the basic protocols which are still now practiced successfully. Though due to the advancement of medical science, it introduce new technique that completely transformed the practice of surgery over the period of time.Incisions are basics of surgery which has both Surgical and Anatomical importance. Surgical view of incision avoids cosmetic damage and anatomical view provide safeguard to vital structures. Acharya Sushruta stated specific incisions in relation to various parts of bodyas well as in relation to the specific diseases.There are number of incisions explained by Sushruta, like Tiryak, Chandrakara, Ardhacandhrakara, Langalak, Ardhalangalaketc.Hence an attempt made to elaborate different types of incisions told in SushrutaSamhita with their scientific validation. Anjaneya | Syeda Ather Fathima | Shivalingappa J. Arakeri | Mohasin Kadegaon | Geethanjali Hiremath "A Review Article on Different Types of Incisions According to Sushruta" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-6 , October 2021, URL: https://www.ijtsrd.com/papers/ijtsrd47661.pdf Paper URL : https://www.ijtsrd.com/medicine/ayurvedic/47661/a-review-article-on-different-types-of-incisions-according-to-sushruta/anjaneya
Jalaukavacharana - Leech Therapy in AyurvedaDr Adithya J V
Leech Therapy in Ayurveda - A unique modality of treatment in Ayurveda - Insights into Scientific Aspects, Mode of Usage and its scope in treatment of Various Diseases.
Acharya sushruta well known about Importance of Vranashopha stages of abscess formation , Vrana wound and their management in surgical practice. The vranashopha is descrided as earlier phase of vrana. Sushruta has mentioned detail description of inflammatory swelling under the heading of vranashopha. Which has three progressive stages. These are amawastha early stage of inflammatory process , Pachyamanavastha true inflammatory stage respectively. Further Acharya described six types of vranashopha as Vattika, Paittika, shleshmika, Shonita, Sannipattaja, and Agantuja. He described their description according to colour, consistency, Pain, And other symptoms. Acharya sushruta perceived that the process of pathogenesis has a definite sequential pattern distributed over six occasions for treatment called shatkriyakala. Sixty procedures for management of vranashopha inflammatory swelling and vrana abscess was told by sushruta. Out of these first eleven from apatarpana to virechana were mentioned eight procedures were truly for vrana only. It is very important to know all about vranashopha as and treatment in this stage can prevent hazardous complications occur by infected wound. Dr. Chandrakant Budni "Conceptual Review on Vranashopha" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-4 , June 2022, URL: https://www.ijtsrd.com/papers/ijtsrd50114.pdf Paper URL: https://www.ijtsrd.com/medicine/ayurvedic/50114/conceptual-review-on-vranashopha/dr-chandrakant-budni
LN Ayurved College & Hospital, Kolar Road, Bhopal professor of Panchakarma and Head of the department Dr K Shiva Rama Prasad has delivered a Guest lecture on the Importance and Standard procedures of Raktamokshana at Institute of Post Graduate Ayurvedic Education & Research under Dept. of Health & Family Welfare, Government of West Bengal on 18th November 2019.
Shock is the state of not enough blood flow to the tissues of the body as a result of problems with the circulatory system.Initial symptoms may include weakness, fast heart rate, fast breathing, sweating, anxiety, and increased thirst. This may be followed by confusion, unconsciousness, or cardiac arrest as complications worsen.
Shock is divided into four main types based on the underlying cause: low volume, cardiogenic, obstructive, and distributive shock. Low volume shock may be from bleeding, diarrhea, vomiting, or pancreatitis. Cardiogenic shock may be due to a heart attack or cardiac contusion. Obstructive shock may be due to cardiac tamponade or a tension pneumothorax. Distributed shock may be due to sepsis, spinal cord injury, or certain overdoses.
The diagnosis is generally based on a combination of symptoms, physical examination, and laboratory tests. A decreased pulse pressure (systolic blood pressure minus diastolic blood pressure) or a fast heart rate raises concerns. The heart rate divided by systolic blood pressure, known as the shock index (SI), of greater than 0.8 supports the diagnosis more than low blood pressure or a fast heart rate in isolation.
Treatment of shock is based on the likely underlying cause.[2] An open airway and sufficient breathing should be established.[2] Any ongoing bleeding should be stopped, which may require surgery or embolization.[2] Intravenous fluid, such as Ringer's lactate or packed red blood cells, is often given.[2] Efforts to maintain a normal body temperature are also important.[2] Vasopressors may be useful in certain cases.[2] Shock is both common and has a high risk of death.[3] In the United States about 1.2 million people present to the emergency room each year with shock and their risk of death is between 20 and 50%
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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!
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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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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Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
2. Samanya lakshana of marmaghata
देहप्रसुप्तिर्ुुरुिा सम्मोहः शीिकाममिा| स्वेदो मूर्च्ाु वममः श्वासो ममुववद्धस्य
लक्षणम्|| A.S. Sa. 7/47
Numbness , spasm/heaviness, confusion/ nervousness, thirst, sweating,
unconsciousness, vomiting, dyspnea are the common features of
marmaghata.
4. DEFINITION
Shock is a systemic state of low tissue perfusion,
which 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.
6. Cellular
Cells run-down with oxygen and glucose
Aerobic respiration turns to Anaerobic
Collection of lactic acid lead to metabolic acidosis
As glucose exhausted respiration ceases
Sodium potassium pump stop
Intracellular lysosomes release autodigestive enzymes and cell lysis ensues
Intracellular contents, including potassium, are released into the bloodstream.
7. Micro-vascular
As tissue ischemia progresses, changes in the local environment
activation of the immune and coagulation systems
generation of oxygen free radicals and cytokine release
injury of the capillary endothelial cells.
Damaged endothelium loses its integrity and becomes ‘leaky’
Spaces between endothelial cells allow fluid to leak out and tissue oedema ensues,
worsening cellular hypoxia
9. Cardiovascular
As preload and afterload decrease
Compensatory baroreceptor response resulting in increased
sympathetic activity and release of catecholamines into the
circulation.
This results in tachycardia and systemic vasoconstriction
(except in sepsis).
10. Respiratory
The metabolic acidosis and increased sympathetic response
Increased respiratory rate and tiny ventilation
Leads to increase the excretion of carbon dioxide
(and so produce a compensatory respiratory alkalosis).
11. Renal
Decreased perfusion pressure in the kidney
Leads to reduced filtration at the glomerulus
Resulting decreased urine output.
The renin–angiotensin–aldosterone axis is stimulated
Resulting in further vasoconstriction and increased sodium and water
reabsorption by the kidney
12. Endocrine
As well as activation of the adrenal and renin–angiotensin systems
Vasopressin (antidiuretic hormone) is released from the hypothalamus in
response to decreased preload and results in vasoconstriction and
reabsorption of water in the renal collecting system.
Cortisol is also released from the adrenal cortex, contributing to the
sodium and water reabsorption and sensitizing the cells to
catecholamines
13. Ischaemia–reperfusion syndrome
Tissue damage due to Hypoxia & local inflammation
Normal circulation is restored
The acid and potassium recirculate in body
Can lead to direct myocardial depression, vascular dilatation and
further hypotension
14. The cellular and humoral elements activated by the hypoxia
(complement, neutrophils, micro-vascular thrombi) are flushed back
into the circulation
They causes further endothelial injury to organs such as the lungs
and kidneys
This leads to acute lung injury, acute renal injury, multiple organ
failure and death.
15. How to avoid ????
Reducing the extent and duration of tissue hypo-perfusion.
16. Classification of shock (HODEC)
There are various classification of shock but most
clinical approachable is on the basis of initiating
mechanism
•Hypovolemic
•Obstructive
•Distributive
•Endocrine
•Cardiogenic
17.
18. Hypovolemic
Caused by a reduced circulating volume May be:
Hemorrhagic
Non-hemorrhagic (dehydration, excessive fluid loss by diarrheoa,
vomiting, urinary or fluid in third space i.e. exudation)
Hypovolemia is probably the most common form of shock and is to
some degree a component of all other forms of shock. Absolute or
relative hypovolemia must be excluded or treated in the
management of the shocked state, regardless of cause.
19. Cardiogenic shock
Failure of the heart to pump blood to the tissues.
Causes
Myocardial infarction, cardiac dysrhythmias, valvular heart disease,
blunt myocardial injury and cardiomyopathy.
Cardiac insufficiency may also be caused by myocardial depression
resulting from endogenous factor like (e.g. bacterial and humoral
agents released in sepsis) or exogenous factors, such as
pharmaceutical agents or drug abuse.
Evidence of venous hypertension with pulmonary or systemic oedema
may coexist with the classic signs of shock.
20. Obstructive shock
In obstructive shock there is a reduction in preload because of
mechanical obstruction of cardiac filling.
Cardiac tamponade, tension pneumothorax, massive pulmonary
embolus and 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
21. Distributive shock
Inadequate organ perfusion is complemented by vascular dilatation
with hypotension, low systemic vascular resistance, inadequate
afterload and a resulting abnormally high cardiac output.
Present in
• Anaphylaxis
• Septicemia ( septic shock)
• Spinal cord injury
22. Endocrine shock
Endocrine shock may present as a combination of hypovolaemic,
cardiogenic and distributive shock.
Causes of endocrine shock include hypo- and hyperthyroidism and
adrenal insufficiency.
Hypothyroidism causes a shock result of disordered vascular and cardiac
responsiveness to circulating catecholamines. Cardiac output falls
because of low inotropy and bradycardia. There may also be an
associated cardiomyopathy.
Thyrotoxicosis may cause a high-output cardiac failure.
23. Adrenal insufficiency leads to shock as a result of hypovolaemia
and a poor response to circulating and exogenous catecholamines.
Adrenal insufficiency may result from pre-existing Addison’s
disease or it may be a relative insufficiency caused by a pathological
disease state such as systemic sepsis.
25. Compensated shock
Apart from a tachycardia and cool peripheries (vasoconstriction, circulating
catecholamines) there may be no other clinical signs of hypovolaemia.
This condition is occult tissue perfusion this state will lead to multiple organ failure
and death if prolonged because of the ischaemia–reperfusion effect.
Patients with occult hypo-perfusion (metabolic acidosis despite normal urine
output and cardiorespiratory vital signs) for more than 12 hours have a
significantly higher mortality rate, infection rate and incidence of multiple organ
failure.
In general, loss of around 15% of the circulating blood volume is within normal
compensatory mechanisms.
Kidneys
Lungs
Brain
Skin
Muscle
Gastrointestinal tract.
26. De-compensation
Further loss of circulating volume overloads the body’s
compensatory mechanisms and there is progressive renal,
respiratory and cardiovascular de-compensation.
Blood pressure is usually well maintained and only falls after
30–40% of the circulating volume has been lost.
27. Mild shock
Mild shock Initially there is tachycardia, tachypnoea and a mild
reduction in urine output and the patient may exhibit mild
anxiety.
Blood pressure is maintained although there is a decrease in
pulse pressure. The peripheries are cool and sweaty with
prolonged capillary refill times (except in septic distributive
shock).
28. Moderate shock
As shock progresses, renal compensatory mechanisms
fail, renal perfusion falls and urine output dips below
0.5mlkg–1h–1.
There is further tachycardia and now the blood pressure
starts to fall.
Patients become drowsy and mildly confused.
29. Severe shock
In severe shock there is profound tachycardia and
hypotension.
Urine output falls to zero and patients are
unconscious with laboured respiration.
30. Clinical feature Compensated Mild Moderate Severe
Lactic acidosis + ++ ++ +++
Urine output Normal Normal Reduced Anuric
Level of
consciousness
Normal Mild anxiety Drowsy Comatose
Respiratory
rate
Normal Increased Increased Laboured
Pulse rate Normal Increased Increased Increased
Blood pressure Normal Normal Mild
hypotension
Severe
hypotension
Clinical feature of shock
31. Pitfalls
The problem is that all these classical sign symptoms are not present in every patient.
Patient may have shock despite the absence of these classical sign.
1. Capillary refill
2. Tachycardia
3. Blood pressure
33. RESUSCITATION
Resuscitation should not be delayed in order to definitively diagnosis…
1. The timing and nature of resuscitation will depend on the type of shock and the
timing and severity of the insult.
2. Rapid clinical examination will provide adequate clues to make an appropriate first
determination, even if a source of bleeding or sepsis is not immediately identifiable.
3. If there is initial doubt about the cause of shock it is safer to assume the cause is
hypovolaemia and begin with fluid resuscitation, followed by an assessment of the
response.
4. If patient is actively loosing blood, operative haemorrhage control should not be
delayed and resuscitation should proceed in parallel with surgery. If patient not
loosing blood actively then must be resuscitated before underwent surgery. For eg in
bowel obstruction leading shock patient must resuscitated before surgery.
34. Fluid therapy
1. In all cases of shock, regardless of classification, hypovolaemia and inadequate
preload must be addressed before other therapy is instituted.
2. Therefore, First-line therapy is intravenous access and administration of
intravenous fluids.
3. Access should be through short, wide-bore catheters that allow rapid infusion of
fluids as necessary.
35. Type of fluids
1. Blood
2. Crystalloid ( Normal saline, Ringer’s lactate, Hartmann’s solution)
3. Colloid (albumin or commercially available products)
36. Dynamic fluid response
The shock status can be determined dynamically by the cardiovascular
response to the rapid administration of a fluid bolus. The 250-500 ml fluid
should be given in first 5-10 minute and the response of therapy must be
observed in term of-
1. Heart Rate
2. Blood Pressure
3. Central Venous Pressure (CVP)
Patients can be divided into ‘responders’, ‘transient responders’ and
‘non-responders’.
37. Responders
1. Severely volume
depleted and are likely
to have major on-
going loss of
intravascular volume,
usually through
persistent
uncontrolled
haemorrhage.
1. Improvement but
then revert to their
previous state over
the next 10–20min.
2. These patients
have moderate on-
going fluid losses
1. Improvement in
their cardiovascular
status, which is
sustained.
2. These patients are
not actively losing
fluid but require
filling to a normal
volume status
Non-
responders
Transient
responders
38. Vasopressor and inotropic support
Not included in first line therapy for shock..
1. Vasopressor agents (phenylephrine, noradrenaline) are
indicated in distributive shock states.
2. In cardiogenic shock or when myocardial depression
complicates a shock state (e.g. severe septic shock with low
cardiac output), inotropic therapy may be required to increase
cardiac output and, therefore, oxygen delivery. The inodilator
dobutamine is the agent of choice.
40. Endpoints of resuscitation
1. Traditionally patients have been resuscitated until they
have a normal pulse, blood pressure and urine output.
2. Resuscitation algorithms directed at correcting global
perfusion endpoints are base deficit, lactate, mixed
venous oxygen saturation.