This document provides an overview of different types of shock, including hypovolemic, cardiogenic, septic, anaphylactic, and neurogenic shock. It describes the pathophysiology, clinical manifestations, diagnosis, and treatment principles for each type. Hypovolemic shock is the most common and results from reduced circulating volume due to causes like bleeding or dehydration. Septic shock involves systemic inflammation and vasodilation in response to infection. Treatment focuses on fluid resuscitation, vasopressor support, source control, and antibiotics depending on the shock etiology.
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The main idea is the incompatibilities that accrue between the IV drug with drug, solution, container and IV set .
Simple study of incompatibilities of drug admixtures in Iraq , that accrue heavily in pharmacy and hospitals, it incorrect because the compliance of patient not a reason for admixture and we didn't found any study on this admixtures that confirm it safety. At last it very important to avoid it because the great risk .
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The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
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3. Hypovolemic Shock
• most common
• reduced circulating volume
Hemorrhagic shock
External or Internal
Non Hemorragic hypovolemic shock
Vomiting Diuresis
Diarrhoea Burns
4. Pathophysiology of Hypovolemic shock
Hypovolemia
Multiorgan failure
↓Venous
Return
↓Preload
CO = SV x HR
↓Cardiac output
BP = CO x TPR
Hypotension
Perfusion failure &
Tissue hypoxia
Organ dysfunction
5. Bodily responses
Physiologic responsessympathetic activity – tachycardia and SVR
Hyperventilation
collapse of venous capacitance vessels
stress hormones
Attempt to replace intravascular volume loss
The body will prioritize – Brain and heart
Severity ~ magnitude and the rate of fluid loss
9. Treatment principles:
Hypovolemic Shock
• control ongoing loss
• rapid reexpansion of the circulating
intravascular blood volume
• GOAL: restore blood volume and improve
tissue perfusion and oxygenation
10. Control bleeding
•
•
•
•
•
Direct pressure on the site of wound, Gauze
Elevation
Pressure points Tourniquets Surgical Methods
•
•
•
•
Artery forceps (Spencer Well’s forceps)
Ligation
Cauterisation
Splenectomy – splenic rupture, Hysterectomy for post
partum bleeding
11. Treatment contd.
• ABC …
– Supplemental Oxygen
– Endotracheal intubation
• Secure a large bore IV line for fluid
resuscitation
– Median cubital vein, saphenous vein and
sometimes the internal jugular and subclavian
veins
– In pediatric patient - intraosseus line
12. Re-expansion of Intravascular volume
Fluid Therapy
Crystalloid solutions –
0.9% saline
Ringer Lactate
Colloid solutions – 5% albumin, gelatins, hetastarch
20 ml/kg in 5 – 15 minutes – repeat upto 60 ml/kg
Blood transfusion – 1 unit of blood in 20 minutes
>40% of blood loss (class IV)
If the patient is anemic ( Hg < 8g/dl)
We may need to supplement fresh frozen plasma and platelates
15. Septic Shock
Sepsis
• Septicemia - Presence of microbes or their toxins
Sepsis and organ
in blood
dysfunction, hypoperfusion,
Severe Sepsis
or hypotension
• Sepsis – Systemic inflammatory response
syndrome (SIRS) that has a proven or suspected
microbial etiology
Septic
Sepsis-induced
hypotension
• Severe sepsis – Hypoperfusion with signs of organ
shock
dysfunction – Lactic acidosis, oliguria etc.
• Septic shock - Sepsis + hypotension (ABP<90
mmHg systolic, or MODS
40 mmHg less than patient's
normal BP) for at least 1 hr despite adequate fluid
resuscitation;
Death
16. Septic, contd.
• Importance??
– The most common of the distributive types,
– The leading cause of Deaths in ICU in the US.
– Increasing in occurrence
• Increased life support for high risk patients
• Increase in invasive procedures
• Growing number of the immunocompromised
– HIV
– Chemotherapy
23. Principles of treatment:
Septic shock
• Ventilatory support
• IV fluids – crystalloids or colloids - Fill the tank
• Vasoactive agents – Norepinephrine,
Dopamine etc.
• Draw blood for culture – before Antibiotics
• Remove septic focus – Resect a gangrenous
bowel, Drain an abscess
• Early empirical antibiotic therapy
24. Neurogenic Shock
• Cause – high spinal cord injury, spinal
anaesthesia
• Pathophysiology - Interruption of
sympathetic vasomotor input
• extremities are warm
• Rx – IV fluids
• norepinephrine or a pure -adrenergic agent
(phenylephrine)
31. References
• Harrison’s principles of internal medicine18th edition
• ACS surgery: principles & practice
• Mannipal manual of surgery
• Robbin’s basic pathology
• Shwartz principles of surgery
• Davidson’s principles and practice of medicine
• World Wide Web