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Shock
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- 2. What is Shock? •Shock is the “physiologic state characterized by significant reduction of systemic tissue perfusion, resulting in decreased tissue oxygen delivery.” • Tissue perfusion is dependent on systemic vascular resistance (SVR) and cardiac output (COP). • Imbalance between oxygen delivery and oxygen consumption which leads to cell death, end organ damage, multi-system organ failure, and death
- 3. Types of Shock •Hypovolemicshock •Traumatic shock •Cardiogenic shock Intrinsic Compressive •Distributive shock Septic shock Anaphylactic shock Neurogenic shock Hypoadrenal shock • Obstructive shock
- 4. 1) Cardiogenic Shock •Shockcaused as a result of cardiac pump failure •Results in a decrease in capillary osmotic pressure(COP) •Systemic vascular resistance(SVR) is increased in an effort to compensate to maintain organ perfusion •Causes: •Myocardial Infarction •Arrythmias (Atrial fibrillation, ventricular tachycardia, bradycardia, etc.) •Mechanical abnormalities (valvular defects) •Extracardiac abnormalities (PE, pulmonary HTN, tension pneumothorax)
- 5. Pathophysiology of CardiogenicShock Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
- 6. Treatment of CardiogenicShock •Fluid is not routinely advised •Inotropic or Vasopressor support: • Dobutamine • Norepinephrine • Dopamine • Epinephrine • Oxygenation • If MI – Aspirin, Heparin, and Revascularization • If arrythmia – correct arrythmia • If extracardiac abnormality – reverse or treat cause
- 7. 2) Hypovolemic Shock •Shockcaused by decreased preload due to intravascular volume loss (1/5 of blood volume) •Results in decreased COP •SVR is typically increased in an effort to compensate •Causes: •Hemorrhagic –( trauma, GI bleed, hemorrhagic pancreatitis, fractures) •Fluid loss induced – (Diarrhea, vomiting, burns)
- 8. Pathophysiology of HypovolemicShock Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
- 9. #Treatment of HypovolemicShock •Maximize oxygen delivery •Control further blood loss •Tourniquets •Surgical intervention •Fluid resuscitation •NS fluid boluses •Blood product administration
- 10. 3) Distributive Shock •Shockas a result of severely diminished SVR •COP is typically increased in an effort to maintain perfusion •Subtypes: a) Septic – secondary to an overwhelming infection b) Anaphylactic – secondary to a life-threatening allergic reaction c) Neurogenic – secondary to a sudden loss of the autonomic nervous system function
- 11. #Treatment of SepticShock •Resuscitate • 30cc/kg of NS bolus •Identify Source • Pan cultures • CT scan • Line removal • Foley removal • Surgical exploration •Antibiotics
- 12. #Treatment of AnaphylacticShock •Remove offending agent •Establish an airway and return circulation •Pharmacologic support: • Epinephrine – reverses peripheral vasodilation, dilates bronchial airways, increases myocardial contractility, and suppresses histamine/ leukotriene release • Antihistamine--may help counter histamine-mediated vasodilation and bronchoconstriction • Corticosteroids (hydrocortisone) – may help shorten reaction • Bronchodilators
- 13. Neurogenic Shock •Hemodynamic phenomenonthat can occur within 30 minutes of a spinal cord injury at the fifth thoracic (T5) vertebra or above and can last up to 6 weeks •Results in massive vasodilation leading to pooling of blood in vessels
- 14. Pathophysiology of NeurogenicShock Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
- 15. #Treatment of NeurogenicShock •Establish an airway to maintain adequate oxygenation and ventilation •Fluid resuscitation for mean arterial pressure(MAP)>65mmHg •Inotropic support Dobutamine Dopamine •Atropine for severe bradycardia •High dose methylprednisolone therapy
- 16. All three typesof shock can occur at the same time to have a combined shock picture.
- 17. Take the massage Survivaland outcomes improve with early perfusion, adequate oxygenation, and identification with appropriate treatment of the cause of shock.