1. Shock is defined as inadequate tissue perfusion and cellular dysfunction due to an imbalance between oxygen delivery and demand.
2. There are several types of shock including hypovolemic, cardiogenic, obstructive, anaphylactic, and neurogenic shock.
3. Hypovolemic shock occurs due to loss of intravascular volume from hemorrhage, burns, or fluid losses. Cardiogenic shock results from cardiac failure leading to low cardiac output. Obstructive shock involves obstruction of venous return such as from tension pneumothorax.
Shock
what is shock
stages of shock
types of shock, their presentation and management
presentation is made for medical students using kumar and clark and guyton.
Shock
what is shock
stages of shock
types of shock, their presentation and management
presentation is made for medical students using kumar and clark and guyton.
DYSPNOEA IS DEFINED AS THE UNDUE AWARENESS OF UNPLEASANT BREATHING.WHEN THERE IS AMIS MATCH BETWEEN THE AFFERENT VENTILATORY SIGNALS AND THE EFFERENT RESPIRATORY SIGNALS IN THE BRAIN WE MAY GET AN UNIGNORABLE FEELING FOR NEED OF MORE AND MORE OXYGEN.
sepsis and septic shock, sepsis six bundle, fluid resuscitation, lactic acid, antibiotics, urine output, mortality 40%, nurses and health care professionals
Rhabdomyolysis is potentially life-threatening syndrome due to breakdown of skeletal muscle fibers
with leakage of muscle contents into the circulation, The outcome varies depending on the extent of kidney damage, To avoid this problem Keep yourself always hydrated well supplemented with electrolytes & carbohydrates. Avoid drugs, alcohol, excessive heat & over-exercising,
DYSPNOEA IS DEFINED AS THE UNDUE AWARENESS OF UNPLEASANT BREATHING.WHEN THERE IS AMIS MATCH BETWEEN THE AFFERENT VENTILATORY SIGNALS AND THE EFFERENT RESPIRATORY SIGNALS IN THE BRAIN WE MAY GET AN UNIGNORABLE FEELING FOR NEED OF MORE AND MORE OXYGEN.
sepsis and septic shock, sepsis six bundle, fluid resuscitation, lactic acid, antibiotics, urine output, mortality 40%, nurses and health care professionals
Rhabdomyolysis is potentially life-threatening syndrome due to breakdown of skeletal muscle fibers
with leakage of muscle contents into the circulation, The outcome varies depending on the extent of kidney damage, To avoid this problem Keep yourself always hydrated well supplemented with electrolytes & carbohydrates. Avoid drugs, alcohol, excessive heat & over-exercising,
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My last seminar in Pg.....Less amount of words to describe....Pictorially well represented....Videos may or may not be played in PPT versions below MS Office2013
Physiology of shock explains different kind of shock and their management. Made by Dr.Nitin Khajotia.
Septic shock
Cardiogenic shock
Anaphylactic shock
Septic shock (due to infections)
Neurogenic shock (caused by damage to the nervous system)
Signs and Symptom
management of shock general
definition of heart failure, classification of heart failure, risk factors for heart failure, clinical features, general physical examination findings in heart failure
Physiology of shock explains different kind of shock and their management. Made by Dr.Nitin Khajotia.
Septic shock
Cardiogenic shock
Anaphylactic shock
Septic shock (due to infections)
Neurogenic shock (caused by damage to the nervous system)
Signs and Symptom
management of shock general
Animated slides doctor explains shock
This PowerPoint talks about shocks and their types, also how it is treated and what their causes and symptoms. this PowerPoint is for college students.
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.
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
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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.
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
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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!
2. Definition
Shock is the clinical syndrome
Inadequate tissue perfusion
The hypoperfusion-induced imbalance
between the delivery & requirements for
oxygen
Substrate leads to cellular dysfunction
3. Types of Shock
SHOCK
Low stroke
volume
Hypovolaemic
Haemorrhage
Burn
Salt & water loss
Cardiogenic
MI
acute mitral
regurgitation
Obstructive
PE
Cardiac Tamponade
Tension
pneumothorax
Vasodilatation/
Distributive
Sepsis/SIRS
infection
Anaphylactic
Injection-penicillin
Bee sting
Anesthetics
selfish
Neurogenic Trauma to spinal cord
Spinal anesthesia
6. Hypovolaemic shock
Due to
a) Haemorrhage
-External from wounds, open fractures
-Internal from injury to spleen, liver,
mesentery or pelvis
b) Severe burn which result in loss of plasma
C) intestinal obstruction
c) Diarrhoea & vomiting of any cause
7. Hypovolaemic shock- Pathophysiology
Due to sudden loss blood volume or fluid from the vascular space.
Loss of blood
Filling of rt. Heart
Filling of pulmonary
vasculature
Filling of left
atrium & ventricle
Stroke
volume
Arterial
BP
SHOCK
9. Hypovolaemic shock- Management
ABC (AIRWAY is always first)
Control hemorrhage (splint the limb)
Obtain IV access with wide bore cannula
Resuscitate with fluids and blood
- Isotonic saline/ ringer’s lactate solution
- Blood transfusion if Hb <10g/dl
**Supplemental oxygen should always be
provided
10. Management goals AFTER securing the ABCs..
• STOP THE BLEEDING
• RESTORE VOLUME
• CORRECT ANY ELECTROLYTE/ACID-BASE
DISTURBANCES
Monitoring
Urine output
Vital signs
Skin perfusion
SP02 - Pulse Oximetry
12. Cardiogenic shock /Acute circulatory Failure
• Is a state of end-organ hypoperfusion due to
cardiac failure.
• Cardiogenic shock
-systemic hypoperfusion due to severe
depression of the cardiac index (<2.2 [L/min]/m2)
- sustained systolic arterial hypotension (<90
mmHg) despite an elevated filling pressure
(pulmonary capillary wedge pressure [PCWP]
>18 mmHg)
13. Causes of Cardiogenic shock
Systolic dysfunction
- CAD : Acute MI or ischemia (most common )
- Other conditions :
severe myocarditis
end stage cardiomyopathy
Prolonged cardiopulmonary bypass
Diastolic dysfunction
- CAD
- ventricular hypertrophy
14. Valvular or structural abnormality
(acute valve failure)
Aortic Regurgitation
-Aortic dissection
-Infective endocarditis
Mitral regurgitation
-Papillary muscle rupture due to acute MI
-Infective endocarditis
Prosthetic valve failure
-Mechanical valves: fracture , jamming, thrombosis
-Biological valves: degeneration with cusp tear
15. Arrhythmia
- VT/VF, bradycardia can cause shock
- sinus tachycardia can aggravate shock
Others
Restrictive cardiomyopathy
HOCM with Severe outflow obstruction
Prolong hypovolemia or septic shock
β-Blocker/CCB overdose
17. Risk factors for Cardiogenic Shock
Older Age
Prior MI
Diabetes Mellitus
HTN
Anterior MI
Extensive coronary artery stenosis
History of HF
STEMI New LBBB
18. Diagnosis
• Proper history & clinical examination
• ECG
• Chest X-ray
• Echocardiogram
• Blood specimen for laboratory investigation
** Supportive therapy must be initiated
simultaneously with diagnostic evaluation
19. Clinical findings
SIGN SYMPTOMS
Pulse weak , rapid (90-110BPM) / Severe
bradycardia due to HB
Systolic BP (<90mmHg)
Narrow pulse pressure (<30 mmHg)
Tachypnea
JVP distention
Soft s1 & an s3 gallop may found
Systolic murmurs- Severe MR, VSR
Crackles – LV failure
Oliguria
Chest pain
Vomiting
Palpitation
Dyspnea
Appear pale
Altered mental state
20.
21. A. General Measures
• In addition to immediate treatment of acute MI initial
therapy aimed
• Maintaining systemic BP by Vasopressors
• Ensure LV filling pressure by adjusting volume status
• Correct hypoxemia & acidosis
• May need ventilatory support
• Negative ionotropics must stopped
22. B. Pharmacological support
• VASOPRESSORS
Norepinephrine
-Potent vasoconstrictor & Inotropic stimulant
-May cause arrhythmia
-Can be used as initial vasopressor
therapy
-DOSE: 2-4µg/min to max. 15µg/min
Dopamine -Dose depended hemodynamic effect
-Better than Norepinephrine
-DOSE: 2-5µg/kg/min to max. 20-
50µg/kg/min
Dobutamine -Synthetic sympathomimetic amine
-Positive inotropic action
-DOSE: 10µg/kg/min
23. Inotropes and Vasopressors
(ACC/AHA Guidelines)
• SBP <70 mmHg
Norepinephrine (2-4µg/min to max. 15µg/min)
Switch to Dopamine (2-4µg/min to max. 15µg/min) once SBP ≥80
• SBP 70-100 mmHg
Dopamine (2-4µg/min to max. 15µg/min)
Add Dobutamine (2-20 g/kg/min) once SBP ≥90
24. C. Mechanical support
IABP
- Improve coronary & peripheral perfussion
- Initiate as quick as possible
- Higher rates of survival in high use centers
Newer devices
- LV, RV or BiV assist. Devices
- Impella, tendem heart, Extarcorporeal life
support (ECLS)
- Trials have shown hemodynamic
improvement but no survival benefit found
26. E. Treatment according to cause
Shock due to
RV infract
-3% of cardiogenic shock due to RV infract
& inf. Ischemia
-Fluid resuscitation
-Dopamine / Dobutamine
-Early reestablishment of infract artery flow
27. MR -Severe MR due to rupture papillary muscle
-Diagnosis: Echo-Doppler
-Rapid stabilization with IABP
-Dopamine / Dobutamine
VSR -Diagnosis: Echo-Doppler(Blood shunting Lt. to
Rt. & open in interventricular septum)
-Rapid stabilization with IABP
-Dopamine / Dobutamine
28. AHA Guideline
Class I
1. Early revascularization (PCI/CABG)
2. Fibrinolysis in candidates unsuitable for ERV with
no contraindications
Class II a
1. Use of IABP can be useful in pt. with CS who
don’t quickly stabilize with pharmacologic therapy
Class II b
Alternative LV assist device may be considered in pt
with refractory CS
30. Anaphylactic shock
• What is anaphylaxis??
A manifestation of immediate hypersensitivity
A sensitized individual to
A specific antigen results in
life-threatening respiratory distress
followed by vascular collapse and shock
accompanied by pruritis, urticaria, and
angioedema
31. Etiology
• Medications, including antibiotics (especially penicillin
and sulfa), vaccines, opiates, aspirin, NSAIDs, local
anesthetics, intravenous fluids with dextran, and insulin
• Foods, such as nuts, milk, eggs, soy, wheat, and
seafood
• Stings by fire ants and Hymenoptera species (eg, bees,
wasps, yellow jackets, hornets)
• Latex
• Blood products, including plasma, immunoglobulin,
cryoprecipitate, and whole blood
• Idiopathic origins
• Exercise causes
36. Obstructive shock
• Extra-cardiac obstruction to flow in the
cardiovascular circuit
• Either impairment of diastolic filling or excessive
afterload
Etiology
- Tension pneumothorax
- Pericardial tamponade
-Massive Pulmonary embolus
-IVC Obstruction
DVT
Gravid uterus on IVC
Neoplasm
-Increased intrathoracic pressure
Excess positive end expiratory pressure
neoplasm
37. • Develops when a lung or chest wall injury is such that it
allows air into the pleural space but cannot out of it (a
one way valve)
• As a result
- Air accumulation & compress the lung
- Shifting the mediastinum
- Compressing contralateral lung
- Increasing intrathoracic pressure
- Reduce Venus return to the heart
- Causes shock
Tension pneumothorax
41. NEUROGENIC SHOCK
• A type of distributive shock that results from the loss or
suppression of sympathetic tone
• Causes massive vasodilatation in the venous vasculature
→ ↓venous return to heart → ↓cardiac output
• Most common etiology: Spinal cord injury
**Neurogenic shock is the rarest form of
shock
42. Causes of Neurogenic Shock
The Common Causes Of Neurogenic Shock Include:
• Blunt or penetrating injury to the spinal cord
• Trauma to the spinal cord from
motor vehicle accidents, sports injuries, falls, stab
and gunshot wounds.
• Improper administration of regional anesthesia can
also cause neurogenic shock.
• Devastating head injury
• Drugs and medications which affect the autonomic
nervous system can also cause neurogenic shock.
43. Pathophysiology of Neurogenic Shock
Disruption of sympathetic nervous system
Loss of sympathetic tone
Venous and arterial vasodilation
↓ venous return
↓ stroke volume
↓ cardiac output
↓ cellular oxygen supply
↓ tissue perfusion
Impaired cellular metabolism
44. Assessment of Neurogenic Shock
• PATIENT ASSESSMENT
-Hypotension
-Bradycardia
-Hypothermia
-Warm, dry skin
- ↓CO
-Flaccid paralysis below level of the spinal lesion
45. Patient Also Experiences
-SOB , rapid and deep shallow breathing.
-Facial pallor, Dizziness, lightheadedness, fainting.
-Nausea and vomiting.
- weakness due to insufficient blood supply.
-may changes in mental state or disorientation.
-Has bluish discoloration of lips and fingers (cyanosis).
-Decreased or absent urine output.
-Sweats profusely.
-Considerable chest pain
-Loss of consciousness
46. Treatment For Neurogenic Shock
• Neurogenic shock is a serious condition
• Requires emergent medical care
• Airway, Breathing and Circulation (ABC)
• Immobilize the patient, especially the spinal region
to prevent any further damage to the spinal cord.
• IV fluids to stabilize the patient's blood pressure
• Inotropic agents, such as dopamine may be infused
for fluid resuscitation, if needed.
• Atropine is given intravenously to manage severe
bradycardia.
• Surgery is needed in case of accident/trauma/ injury/
to the patient
47. Spinal shock Vs Neurogenic
Acute spinal cord injury Hemodynamic phenomenon
Loss of vasomotor tone &
sympathetic tone
Peripheral neurons become
temporarily unresponsive to
brain stimulation
Disruption of autonomic
pathways → Loss of
sympathetic tone →
vasodilatation
C/F: Decreased reflexes
Loss of sensation
Flaccid paralysis below
level of injury
Hypotension
Bradycardia
Poikilothermia
Last days to months (transient) May last up to 6wks