The patient presented with signs of septic shock including altered mental status, tachypnea, and hypotension. He has a history of multiple comorbidities putting him at risk for infection. Initial workup showed bilateral lung crepitations and fever, suggestive of pneumonia as the source of sepsis. Management involved fluid resuscitation, vasopressors to maintain blood pressure, broad-spectrum antibiotics, and monitoring for signs of organ dysfunction due to systemic inflammatory response.
Shock is defined as inadequate tissue perfusion resulting in decreased oxygen delivery and buildup of waste, and can progress from early compensated stages to intermediate stages involving organ damage and late irreversible stages involving multiple organ failure. The document outlines the pathophysiology and stages of shock including effects on body systems, clinical markers, causes, and treatment focusing on restoring tissue perfusion through fluid resuscitation and management of the underlying cause.
Hemorrhage and shock can occur due to abnormal blood loss or inadequate tissue perfusion. Hemorrhage can be internal or external and is classified based on its source and severity. Shock progresses through four stages as blood loss worsens from vasoconstriction to organ failure. The body responds to hemorrhage initially through hemostasis to stop bleeding, but progresses to shock if blood loss is not replaced.
1. Shock is defined as inadequate tissue perfusion resulting from decreased delivery of oxygen and nutrients and inadequate removal of waste from cells.
2. There are four main types of shock: hypovolemic, distributive, cardiogenic, and obstructive.
3. Hypovolemic shock results from loss of intravascular volume from bleeding, vomiting, or diarrhea leading to decreased blood pressure and organ perfusion. Compensatory mechanisms aim to maintain perfusion to vital organs but eventually fail.
This document provides an overview of shock, including its pathophysiology, classification, and treatment. It defines shock as inadequate tissue perfusion for normal cellular respiration. The pathophysiology involves cellular, microvascular, and systemic effects that lead to tissue hypoxia and organ dysfunction. Shock is classified as hypovolemic, cardiogenic, obstructive, distributive, or endocrine. Resuscitation involves fluid resuscitation, vasopressors or inotropes as needed, and monitoring of vital signs and urine output. The goal is to restore adequate perfusion while identifying and treating the underlying cause of shock.
This document provides information on shock, including its definition, types, pathophysiology, clinical features, and management. It defines shock as a state of inadequate tissue perfusion and oxygenation that can lead to organ dysfunction and death. The main types of shock discussed are hypovolemic, septic, and cardiogenic shock. For each type, the document outlines their pathophysiology, signs and symptoms, and general management approach. Overall, it serves as an overview of shock for medical students, covering the essential details of definitions, types, effects on organ systems, and clinical distinctions between compensated and decompensated states of shock.
This document provides an overview of cardiovascular shock, including its definition, physiology, classification, causes, symptoms, treatment, and complications. The main types of shock discussed are hypovolemic, distributive, cardiogenic, and obstructive shock. Hypovolemic shock, caused by decreased blood volume from hemorrhage, burns, or fluid loss, is described in more detail. The body's compensatory responses to hypovolemia like vasoconstriction and increased heart rate are explained. The progression of shock and factors that can cause recovery or lead to irreversible shock are also summarized.
Shock is defined as inadequate tissue perfusion resulting in decreased oxygen delivery and buildup of waste, and can progress from early compensated stages to intermediate stages involving organ damage and late irreversible stages involving multiple organ failure. The document outlines the pathophysiology and stages of shock including effects on body systems, clinical markers, causes, and treatment focusing on restoring tissue perfusion through fluid resuscitation and management of the underlying cause.
Hemorrhage and shock can occur due to abnormal blood loss or inadequate tissue perfusion. Hemorrhage can be internal or external and is classified based on its source and severity. Shock progresses through four stages as blood loss worsens from vasoconstriction to organ failure. The body responds to hemorrhage initially through hemostasis to stop bleeding, but progresses to shock if blood loss is not replaced.
1. Shock is defined as inadequate tissue perfusion resulting from decreased delivery of oxygen and nutrients and inadequate removal of waste from cells.
2. There are four main types of shock: hypovolemic, distributive, cardiogenic, and obstructive.
3. Hypovolemic shock results from loss of intravascular volume from bleeding, vomiting, or diarrhea leading to decreased blood pressure and organ perfusion. Compensatory mechanisms aim to maintain perfusion to vital organs but eventually fail.
This document provides an overview of shock, including its pathophysiology, classification, and treatment. It defines shock as inadequate tissue perfusion for normal cellular respiration. The pathophysiology involves cellular, microvascular, and systemic effects that lead to tissue hypoxia and organ dysfunction. Shock is classified as hypovolemic, cardiogenic, obstructive, distributive, or endocrine. Resuscitation involves fluid resuscitation, vasopressors or inotropes as needed, and monitoring of vital signs and urine output. The goal is to restore adequate perfusion while identifying and treating the underlying cause of shock.
This document provides information on shock, including its definition, types, pathophysiology, clinical features, and management. It defines shock as a state of inadequate tissue perfusion and oxygenation that can lead to organ dysfunction and death. The main types of shock discussed are hypovolemic, septic, and cardiogenic shock. For each type, the document outlines their pathophysiology, signs and symptoms, and general management approach. Overall, it serves as an overview of shock for medical students, covering the essential details of definitions, types, effects on organ systems, and clinical distinctions between compensated and decompensated states of shock.
This document provides an overview of cardiovascular shock, including its definition, physiology, classification, causes, symptoms, treatment, and complications. The main types of shock discussed are hypovolemic, distributive, cardiogenic, and obstructive shock. Hypovolemic shock, caused by decreased blood volume from hemorrhage, burns, or fluid loss, is described in more detail. The body's compensatory responses to hypovolemia like vasoconstriction and increased heart rate are explained. The progression of shock and factors that can cause recovery or lead to irreversible shock are also summarized.
Shock is a life-threatening condition caused by inadequate tissue perfusion. It has several stages from initial to irreversible. The main types are hypovolemic, cardiogenic, obstructive, distributive, and neurogenic. Hypovolemic shock results from a loss of intravascular volume and is the most common type. Diagnosis involves assessing vital signs and fluid status. Treatment focuses on restoring volume with fluids and blood products, addressing the underlying cause, and supporting organ function. Close monitoring for complications is important during resuscitation.
This document discusses shock, including its pathophysiology, classification, clinical features, consequences, and resuscitation. Shock is defined as inadequate tissue perfusion resulting in cellular changes from aerobic to anaerobic metabolism. The main types of shock are hypovolemic, cardiogenic, obstructive, distributive, and endocrine. Left untreated, shock can lead to multiple organ failure and death. Initial resuscitation focuses on airway, breathing, and restoring circulating volume through fluid administration. Ongoing monitoring and support of vital organs is needed until the underlying cause is addressed.
Shock is a state of low tissue perfusion that prevents normal cellular respiration. There are several classifications of shock including hypovolaemic, cardiogenic, obstructive, distributive, and endocrine shock. The key goals of resuscitation are to ensure adequate oxygenation, ventilation, and cardiovascular support through fluid administration and vasopressors if needed. Ongoing monitoring of vital signs, urine output, and markers of tissue perfusion like lactate levels are important to guide resuscitation efforts and avoid complications like multiple organ failure.
2. Hypovolemic, Septic and Cardiogenic Shock.pptxfarihinizhar
Hypovolemic, septic, and cardiogenic shock are three types of shock discussed in the document. Hypovolemic shock occurs due to reduced circulating volume from external or internal bleeding or fluid losses. Septic shock results from toxins released during bacterial infections. Cardiogenic shock is caused by decreased cardiac output due to conditions like heart attacks or heart muscle damage that impair the heart's ability to pump effectively. Treatment for the different shock types involves immediate control of bleeding, fluid resuscitation, antibiotics for infection, and vasopressors or inotropes to support blood pressure and cardiac function.
1. Shock is defined as a systemic state of low tissue perfusion that is inadequate for normal cellular respiration. It occurs when there is insufficient delivery of oxygen and glucose to cells, causing cells to switch from aerobic to anaerobic metabolism. If perfusion is not restored, cell death ensues.
2. The main types of shock are hypovolemic, cardiogenic, obstructive, distributive, and endocrine shock. Hypovolemic shock, the most common type, is caused by blood or fluid loss. Cardiogenic shock results from cardiac dysfunction that reduces cardiac output.
3. The goals of shock resuscitation are to increase oxygen delivery, decrease oxygen demand, improve cardiac
Shock is a life-threatening condition defined by inadequate tissue perfusion and oxygen delivery. It can be caused by hypovolemia, cardiac dysfunction, or vasodilation. The main symptoms include low blood pressure, fast heart rate, fast breathing, and decreased urine output. Untreated shock can lead to organ failure and death. Treatment focuses on restoring circulating volume and oxygen delivery through fluid resuscitation, vasopressors, and treating the underlying cause. Prompt recognition and treatment are essential for recovery.
Shock is characterized by impaired cellular metabolism and decreased tissue perfusion. There are four main types of shock: hypovolemic, vasogenic, cardiogenic, and neurogenic. The stages of shock progression include initial, compensatory, progressive, and irreversible. Management aims to restore fluid volume, increase cardiac output, and remove the precipitating cause. Nursing care focuses on monitoring vital signs, administering IV fluids and oxygen, maintaining perfusion, preventing complications, and supporting organ function.
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 is a clinical condition caused by inadequate tissue perfusion leading to cellular ischemia. The main causes of death in surgical patients are from shock. Shock can be classified as cardiogenic, hypovolemic, distributive, or obstructive. The key features of shock are hypotension, tachycardia, altered mental status, and signs of poor peripheral perfusion. Treatment involves rapid fluid resuscitation to restore perfusion, with blood products as needed. Ongoing fluid needs and use of vasopressors depends on the type and severity of shock. Monitoring includes vital signs, urine output, lactate, and base deficit to guide resuscitation efforts until tissues are fully resuscitated.
Shock is a state of acute circulatory failure leading to decreased organ perfusion, with inadequate delivery of oxygenated blood to tissues and resultant end-organ dysfunction. The mechanisms that can result in shock are divided into 4 categories: (1) hypovolemic, (2) distributive, (3) cardiogenic, and (4) obstructive. While much is known regarding treatment of patients in shock, several controversies continue in the literature. Assessment begins with identifying the need for critical interventions such as intubation, mechanical ventilation, or obtaining vascular access. Prompt workup should be initiated with laboratory testing (especially of serum lactate levels) and imaging, as indicated. Determining the intravascular volume status of patients in shock is critical and aids in categorizing and informing treatment decisions. This issue reviews the 4 primary categories of shock as well as special categories, including shock in pregnancy, traumatic shock, septic shock, and cardiogenic shock in myocardial infarction. Adherence to evidence-based care of the specific causes of shock can optimize a patient's chances of surviving this life-threatening condition.
SHOCK SYNDROMESHOCK SYNDROME
• Shock is a condition in which the cardiovascular system
fails to perfuse tissues adequately
• An impaired cardiac pump, circulatory system, and/or
volume can lead to compromised blood flow to tissues
• Inadequate tissue perfusion can result in:
– generalized cellular hypoxia (starvation)
– widespread impairment of cellular metabolism
– tissue damage organ failure
– death
ATHOPHYSIOLOGYPATHOPHYSIOLOGY
Cells switch from aerobic to anaerobic metabolism
lactic acid production
Cell function ceases & swells
membrane becomes more permeable
electrolytes & fluids seep in & out of cell
Na+/K+ pump impaired
mitochondria damage
cell death
1) Shock is a condition where the cardiovascular system fails to adequately perfuse tissues due to impaired cardiac pump function, circulatory issues, or low blood volume.
2) The main types of shock are hypovolemic (low blood volume), cardiogenic (impaired heart function), and distributive (blood vessel problems).
3) Hypovolemic shock results from internal or external fluid loss leading to decreased circulating volume and tissue perfusion. Cardiogenic shock occurs due to impaired left ventricular pumping ability despite normal blood volume.
Management of hemmorhagic and non hemmorhagic shockMaazBangash
1) Cardiogenic shock, distributive shock, hemorrhagic shock, and obstructive shock are the main types of shock discussed in the document.
2) Cardiogenic shock results from inadequate blood flow due to heart dysfunction and causes tissue hypoperfusion. Treatments focus on restoring blood flow through medications, procedures like angioplasty, and mechanical circulatory support.
3) Hemorrhagic shock occurs when more than 20% of blood volume is lost, such as from severe bleeding. Internal bleeding can be concealed and suggested by symptoms like dizziness. Treatments control hemorrhaging through pressure dressings, tourniquets, and hemostatic dressings.
This document discusses various types of shock and their management. It begins by defining shock as inadequate oxygen delivery to meet metabolic demands, resulting in global tissue hypoperfusion and metabolic acidosis. It then discusses the pathophysiology of different shock states including understanding the body's compensatory mechanisms in shock. It provides guidance on approaching and assessing patients in shock, as well as the goals and methods for treating different shock states, including fluid resuscitation and vasopressor use. Specific types of shock covered include hypovolemic, septic, cardiogenic, anaphylactic, neurogenic, and obstructive shock.
Shock is defined as inadequate tissue perfusion due to decreased oxygen delivery or utilization leading to cellular hypoxia. It is a life-threatening condition characterized by circulatory failure and hypotension. There are four main types of shock: distributive, hypovolemic, cardiogenic, and obstructive. Septic shock, a form of distributive shock, results from a dysregulated immune response to infection leading to vasodilation and hypotension. Management of septic shock involves fluid resuscitation, vasopressor support, antibiotic treatment, and control of the underlying infection. The pathophysiology is complex, involving an interplay between the immune system, inflammatory response, and cardiovascular system.
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%
Shock is caused by inadequate systemic oxygen delivery that activates autonomic responses to maintain circulation. The main types of shock are hypovolemic, septic, cardiogenic, anaphylactic, neurogenic, and obstructive. Treatment focuses on airway control, oxygen delivery, circulation optimization through fluid resuscitation, and achieving hemodynamic goals to restore tissue perfusion. Early goal directed therapy for septic shock involving aggressive fluid administration and inotropes improves outcomes.
Shock is characterized by a systemic reduction in tissue perfusion resulting in decreased oxygen delivery. There are four main types of shock: hypovolemic, cardiogenic, obstructive, and distributive. The goals of resuscitation are to increase oxygen delivery and decrease demand. Treatment involves establishing IV access, fluid resuscitation, vasopressors, inotropes, antibiotics for infection, and treating the underlying cause. Endpoints of resuscitation include restoration of blood pressure, normalization of heart rate, urine output, lactate levels, and mental status.
This document provides an overview of shock, including its definition, pathophysiology, classification, signs and symptoms, initial management, and specific types such as hypovolemic, septic, cardiogenic, and obstructive shock. It defines shock as inadequate tissue perfusion and oxygen delivery, discusses the body's compensatory mechanisms and their failure in severe shock. It classifies shock into hypovolemic, cardiogenic, distributive, and obstructive types and provides details on managing each type, including damage control resuscitation for hemorrhagic shock and use of vasopressors for neurogenic shock. Key goals in shock management are outlined as well as factors like lactate and base deficit that can guide res
Shock in pediatric patients can be caused by several factors and requires early recognition and treatment to prevent progression. It is defined as inadequate oxygen delivery to meet metabolic demands. The main types are hypovolemic, distributive, cardiogenic, and obstructive shock. Septic shock is a major cause of mortality and morbidity in children. The goals of treatment are to increase oxygen delivery, decrease demands, and increase oxygen content through rapid fluid resuscitation and inotropic support. Early identification and treatment of the underlying cause can help avoid irreversible organ damage from shock.
Shock is a life-threatening condition caused by inadequate tissue perfusion. It has several stages from initial to irreversible. The main types are hypovolemic, cardiogenic, obstructive, distributive, and neurogenic. Hypovolemic shock results from a loss of intravascular volume and is the most common type. Diagnosis involves assessing vital signs and fluid status. Treatment focuses on restoring volume with fluids and blood products, addressing the underlying cause, and supporting organ function. Close monitoring for complications is important during resuscitation.
This document discusses shock, including its pathophysiology, classification, clinical features, consequences, and resuscitation. Shock is defined as inadequate tissue perfusion resulting in cellular changes from aerobic to anaerobic metabolism. The main types of shock are hypovolemic, cardiogenic, obstructive, distributive, and endocrine. Left untreated, shock can lead to multiple organ failure and death. Initial resuscitation focuses on airway, breathing, and restoring circulating volume through fluid administration. Ongoing monitoring and support of vital organs is needed until the underlying cause is addressed.
Shock is a state of low tissue perfusion that prevents normal cellular respiration. There are several classifications of shock including hypovolaemic, cardiogenic, obstructive, distributive, and endocrine shock. The key goals of resuscitation are to ensure adequate oxygenation, ventilation, and cardiovascular support through fluid administration and vasopressors if needed. Ongoing monitoring of vital signs, urine output, and markers of tissue perfusion like lactate levels are important to guide resuscitation efforts and avoid complications like multiple organ failure.
2. Hypovolemic, Septic and Cardiogenic Shock.pptxfarihinizhar
Hypovolemic, septic, and cardiogenic shock are three types of shock discussed in the document. Hypovolemic shock occurs due to reduced circulating volume from external or internal bleeding or fluid losses. Septic shock results from toxins released during bacterial infections. Cardiogenic shock is caused by decreased cardiac output due to conditions like heart attacks or heart muscle damage that impair the heart's ability to pump effectively. Treatment for the different shock types involves immediate control of bleeding, fluid resuscitation, antibiotics for infection, and vasopressors or inotropes to support blood pressure and cardiac function.
1. Shock is defined as a systemic state of low tissue perfusion that is inadequate for normal cellular respiration. It occurs when there is insufficient delivery of oxygen and glucose to cells, causing cells to switch from aerobic to anaerobic metabolism. If perfusion is not restored, cell death ensues.
2. The main types of shock are hypovolemic, cardiogenic, obstructive, distributive, and endocrine shock. Hypovolemic shock, the most common type, is caused by blood or fluid loss. Cardiogenic shock results from cardiac dysfunction that reduces cardiac output.
3. The goals of shock resuscitation are to increase oxygen delivery, decrease oxygen demand, improve cardiac
Shock is a life-threatening condition defined by inadequate tissue perfusion and oxygen delivery. It can be caused by hypovolemia, cardiac dysfunction, or vasodilation. The main symptoms include low blood pressure, fast heart rate, fast breathing, and decreased urine output. Untreated shock can lead to organ failure and death. Treatment focuses on restoring circulating volume and oxygen delivery through fluid resuscitation, vasopressors, and treating the underlying cause. Prompt recognition and treatment are essential for recovery.
Shock is characterized by impaired cellular metabolism and decreased tissue perfusion. There are four main types of shock: hypovolemic, vasogenic, cardiogenic, and neurogenic. The stages of shock progression include initial, compensatory, progressive, and irreversible. Management aims to restore fluid volume, increase cardiac output, and remove the precipitating cause. Nursing care focuses on monitoring vital signs, administering IV fluids and oxygen, maintaining perfusion, preventing complications, and supporting organ function.
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 is a clinical condition caused by inadequate tissue perfusion leading to cellular ischemia. The main causes of death in surgical patients are from shock. Shock can be classified as cardiogenic, hypovolemic, distributive, or obstructive. The key features of shock are hypotension, tachycardia, altered mental status, and signs of poor peripheral perfusion. Treatment involves rapid fluid resuscitation to restore perfusion, with blood products as needed. Ongoing fluid needs and use of vasopressors depends on the type and severity of shock. Monitoring includes vital signs, urine output, lactate, and base deficit to guide resuscitation efforts until tissues are fully resuscitated.
Shock is a state of acute circulatory failure leading to decreased organ perfusion, with inadequate delivery of oxygenated blood to tissues and resultant end-organ dysfunction. The mechanisms that can result in shock are divided into 4 categories: (1) hypovolemic, (2) distributive, (3) cardiogenic, and (4) obstructive. While much is known regarding treatment of patients in shock, several controversies continue in the literature. Assessment begins with identifying the need for critical interventions such as intubation, mechanical ventilation, or obtaining vascular access. Prompt workup should be initiated with laboratory testing (especially of serum lactate levels) and imaging, as indicated. Determining the intravascular volume status of patients in shock is critical and aids in categorizing and informing treatment decisions. This issue reviews the 4 primary categories of shock as well as special categories, including shock in pregnancy, traumatic shock, septic shock, and cardiogenic shock in myocardial infarction. Adherence to evidence-based care of the specific causes of shock can optimize a patient's chances of surviving this life-threatening condition.
SHOCK SYNDROMESHOCK SYNDROME
• Shock is a condition in which the cardiovascular system
fails to perfuse tissues adequately
• An impaired cardiac pump, circulatory system, and/or
volume can lead to compromised blood flow to tissues
• Inadequate tissue perfusion can result in:
– generalized cellular hypoxia (starvation)
– widespread impairment of cellular metabolism
– tissue damage organ failure
– death
ATHOPHYSIOLOGYPATHOPHYSIOLOGY
Cells switch from aerobic to anaerobic metabolism
lactic acid production
Cell function ceases & swells
membrane becomes more permeable
electrolytes & fluids seep in & out of cell
Na+/K+ pump impaired
mitochondria damage
cell death
1) Shock is a condition where the cardiovascular system fails to adequately perfuse tissues due to impaired cardiac pump function, circulatory issues, or low blood volume.
2) The main types of shock are hypovolemic (low blood volume), cardiogenic (impaired heart function), and distributive (blood vessel problems).
3) Hypovolemic shock results from internal or external fluid loss leading to decreased circulating volume and tissue perfusion. Cardiogenic shock occurs due to impaired left ventricular pumping ability despite normal blood volume.
Management of hemmorhagic and non hemmorhagic shockMaazBangash
1) Cardiogenic shock, distributive shock, hemorrhagic shock, and obstructive shock are the main types of shock discussed in the document.
2) Cardiogenic shock results from inadequate blood flow due to heart dysfunction and causes tissue hypoperfusion. Treatments focus on restoring blood flow through medications, procedures like angioplasty, and mechanical circulatory support.
3) Hemorrhagic shock occurs when more than 20% of blood volume is lost, such as from severe bleeding. Internal bleeding can be concealed and suggested by symptoms like dizziness. Treatments control hemorrhaging through pressure dressings, tourniquets, and hemostatic dressings.
This document discusses various types of shock and their management. It begins by defining shock as inadequate oxygen delivery to meet metabolic demands, resulting in global tissue hypoperfusion and metabolic acidosis. It then discusses the pathophysiology of different shock states including understanding the body's compensatory mechanisms in shock. It provides guidance on approaching and assessing patients in shock, as well as the goals and methods for treating different shock states, including fluid resuscitation and vasopressor use. Specific types of shock covered include hypovolemic, septic, cardiogenic, anaphylactic, neurogenic, and obstructive shock.
Shock is defined as inadequate tissue perfusion due to decreased oxygen delivery or utilization leading to cellular hypoxia. It is a life-threatening condition characterized by circulatory failure and hypotension. There are four main types of shock: distributive, hypovolemic, cardiogenic, and obstructive. Septic shock, a form of distributive shock, results from a dysregulated immune response to infection leading to vasodilation and hypotension. Management of septic shock involves fluid resuscitation, vasopressor support, antibiotic treatment, and control of the underlying infection. The pathophysiology is complex, involving an interplay between the immune system, inflammatory response, and cardiovascular system.
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%
Shock is caused by inadequate systemic oxygen delivery that activates autonomic responses to maintain circulation. The main types of shock are hypovolemic, septic, cardiogenic, anaphylactic, neurogenic, and obstructive. Treatment focuses on airway control, oxygen delivery, circulation optimization through fluid resuscitation, and achieving hemodynamic goals to restore tissue perfusion. Early goal directed therapy for septic shock involving aggressive fluid administration and inotropes improves outcomes.
Shock is characterized by a systemic reduction in tissue perfusion resulting in decreased oxygen delivery. There are four main types of shock: hypovolemic, cardiogenic, obstructive, and distributive. The goals of resuscitation are to increase oxygen delivery and decrease demand. Treatment involves establishing IV access, fluid resuscitation, vasopressors, inotropes, antibiotics for infection, and treating the underlying cause. Endpoints of resuscitation include restoration of blood pressure, normalization of heart rate, urine output, lactate levels, and mental status.
This document provides an overview of shock, including its definition, pathophysiology, classification, signs and symptoms, initial management, and specific types such as hypovolemic, septic, cardiogenic, and obstructive shock. It defines shock as inadequate tissue perfusion and oxygen delivery, discusses the body's compensatory mechanisms and their failure in severe shock. It classifies shock into hypovolemic, cardiogenic, distributive, and obstructive types and provides details on managing each type, including damage control resuscitation for hemorrhagic shock and use of vasopressors for neurogenic shock. Key goals in shock management are outlined as well as factors like lactate and base deficit that can guide res
Shock in pediatric patients can be caused by several factors and requires early recognition and treatment to prevent progression. It is defined as inadequate oxygen delivery to meet metabolic demands. The main types are hypovolemic, distributive, cardiogenic, and obstructive shock. Septic shock is a major cause of mortality and morbidity in children. The goals of treatment are to increase oxygen delivery, decrease demands, and increase oxygen content through rapid fluid resuscitation and inotropic support. Early identification and treatment of the underlying cause can help avoid irreversible organ damage from shock.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
2. • What is shock?
• Shock is a state of circulatory insufficiency that creates
an imbalance between tissue oxygen supply (delivery)
and oxygen demand (consumption)
• resulting in end-organ dysfunction.
• Reduction in effective perfusion may be due to a local
or global delivery deficiency or utilization deficiency
with suboptimal substrate at the cellular or subcellular
level
SHOCK
3. • Types of shock
• Hypovolemic
• Cardiogenic
• Obstructive
• Distributive Septic, Neurogenic,
Anaphylactic
TYPES OF SHOCK
14. Definition
• A condition in which rapid fluid loss that results
in multiple organ failure due to inadequate
circulating volume and subsequent inadequate
perfusion.
15. • Hypovolemic shock is the most common type of
shock and is caused by insufficient circulating
volume.
• The normal blood volume per body weight of
adult is 7 %, whereas a child is 8-9%.
Hypovolemic Shock
17. Hypovolemic Shock
• Heart pumps well, but not enough blood volume to
pump
MAP = CO x SVR
HR x Stroke volume
↓MAP = ↓ CO (HR x Stroke Volume) x ↑SVR
• Decreased Intravascular volume (Preload) leads to
Decreased Stroke Volume
21. MANAGEMENT
HAEMORRHAGIC HYPOVOLEMIC
FLUID THERAPY
a) 1L of isotonic (0.9% NS or Hartmann’s),
continue until haemodynamic stable
(3L of fluid needed to raise 1L of intravascular
volume)
b) COLLOID or BLOOD PRODUCT
(PACKED CELL/SAFE O/FFP)
c) VASOPRESSOR – if not responding to
fluid
ADULT :
1-2L (10-30cc/kg) crystalloid
(further fluid rhesus with colloid or PC may needed)
IDENTIFY CAUSE & CONTROL BLEEDING IDENTIFY CAUSE
a) IV TRANEXAMIC ACID 1g stat & TDS
b) IV Nexium or pantoprazole 80mg stat
then, IVI infusion 8mg/h over 72H
c) Immobilisation
d) Early wound dressing/ compression
22. Responders
• Sustained improvement in CVS status after bolus
• No active bleeding, require fluids to attain normal volume
status
Transient Responders
• Initial improvement followed by reverting to previous state
over 10-20 min
• Moderate ongoing fluid losses
Non responders
• No improvement in CVS status following bolus
• Severely volume depleted and likely to have ongoing loss(
persistent uncontrolled Hemorrhage)
23. Hemorrhagic shock
• A condition of reduced tissue perfusion resulting in
the inadequate delivery of oxygen and nutrient that
are necessary for cellular function.
• Fluid resuscitation does not stop the bleeding. If the
bleeding doesn’t stop immediately, PUSH TO OT.
• Prior to surgery, if the LOW BP, transfuse IV fluids
and blood .
• If the BP is normal, don’t transfuse,the pressure
might dislodge the blood clots that spontaneous
stop the bleeding.
28. Definition
• Deterioration of tissues / cellular functions with
inadequate supply of oxygen & nutrients
secondary to failure of cardiac function.
29. • As a result of decreased myocardial
contractility and inadequate
systemic vasoconstriction from a
systemic inflammatory response to
extensive myocardial damage.
35. Specific Management
Airway, Breathing, Circulation
• Endotracheal intubation and mechanical ventilation for
patient with excessive work of breathing
• High flow oxygen given via a mask to maintain SaO2 at
>90%
• Intravenous fluids to maintain adequate preload
Intravenous opioids (e.g. morphine 2-4mg) to relieve
pain, induce sedation, block adrenergic discharge and lessen
cardiac stress
36. Specific Management
• Intravenous vasopressors provide inotropic support to
increase perfusion
• To be used with caution to avoid extreme heart rates
which may increase myocardial oxygen consumption,
increase infarct size and impair cardiac pump ability
• Examples : Dobutamine (drug of choice – improve cardiac
contractility), Dopamine, Digoxin
• Intra-aortic balloon pump recommended as a stabilising
measure and combined with thrombolytic therapy if
angiography and revascularization are not readily available.
37. Scenario
• 68-year-old male complaining of shortness of breath. His shortness of breath began after waking
six hours earlier and is progressively getting worse. Since lunch he has been unable to ambulate
without becoming significantly short of breath. He hasn’t been feeling great over the past several
days and has had a productive cough that has occasionally awoken him from sleep.
• History: HTN, previous MI (2002), hypothyroid
• Allergies: none
• Medications:Amlodipine, levothyroxine, warfarin
• Vitals: HR is 130, BP is 106/60, RR is 26/min, SpO2 is 90 percent, DXT-17, Temp- 38.5 C, and
lung sounds are bilateral crepitations up to mid zone.
38.
39. SEPTIC SHOCK
• Sepsis : Life threatening organ dysfunction caused by
dysregulated host response to infection.
• Organ Dysfunction: Change in baseline Sequential
Organ Failure Assessment (SOFA) score
• Quick Sepsis-Related Organ Failure (qSOFA) >2 :
SEPSIS
I. Hypotension : SBP <100 mmHg
II. Altered mental status : GCS <13
III. Tachypnoea: RR >22
40. • Septic Shock :
- Subset in sepsis circulatory and cellular/metabolic abnormalities are profound enough to increase
mortality :
Persistent hypotension require vasopressor to
maintain MAP >65mmHg
Serum Lactate >2mmol/L despite adequate fluid resuscitation
Septic shock presents two phases:
An early warm phase, characterized by normal or increased
• cardiac output and central venous saturation, low
• peripheral vascular resistance, wide pulse pressure,
• bounding pulse, brisk capillary refill (< 3 sec)
A late cold phase, characterized by low cardiac output and central venous saturation, high peripheral vascular
resistance, narrow pulse pressure, weak pulse, delayed capillary refill (> 5 sec)
41.
42. Sepsis : associated with vasodilation, capillary leakage & decreased effective circulating blood volume, reduced venous
return. Then, lead to impaired tissue perfusion and organ dysfunction
MANAGEMENT
FLUID RESUSCITATION IV CRSTALLOID 30cc/kg bolus (within 3H) (max 3-5L)
Reassess hemodynamic status to guide resuscitation
[Dynamic resuscitation markers (Passive leg raise test)]
Cautions in patients with limited cardiorespiratory reserve – fluid overload causing :
• Pulmonary oedema
• Hypoxemic respiratory failure
• Organ oedema
• Intra-abdominal hypertension
• Prolonged ICU stay & mechanical ventilation
VASOPRESSOR Target MAP (65 mmHg)
(Eg : Noradrenaline / Adrenaline)
ANTIMICROBIAL THERAPY ANTIMICROBIAL THERAPY
Broad-spectrum antibiotics
Anti-fungal (consider in) :
Total parenteral nutrition
Recent broad-spectrum antibiotic exposure
Perforated abdominal viscus
Immunocompromised
Clinical suspicious of fungal infection
43. • A 76-year-old obese Malay male with past medical history of hypertension ,chronic obstructive
pulmonary disease diabetes mellitus type II , atrial fibrillation , gastroesophageal reflux disorder,
and benign prostatic hypertrophy presented to the ED with acute-onset shortness of breath. On
initial examination, the patient was in respiratory distress, speaking in phrases, with diffuse
erythema and associated severe pruritus. He described an acute onset of these symptoms
approximately 30 minutes prior to arrival to the ED. On initial evaluation, he gave us a piece of
paper on which he had written “lactulose” implicating this as the new and only medication or
substance he had ingested in the three hours prior to presentation.
• At the time of arrival, the patient’s blood pressure (BP) was 177/143 millimeters of mercury
(mmHg), heart rate (HR) 163 beats per minute (bpm), respiratory rate (RR) 23 breaths per minute,
oxygen saturation of 93% on room air, weight 103 kilograms (kg). He was in acute respiratory
distress in tripod position, with an urticarial eruption on his trunk. Auscultation was significant for
inspiratory and expiratory wheezes in all lung fields. Oropharyngeal exam revealed an edematous
soft palate with a brawny texture and elevation of his tongue to the hard palate, with associated
difficulty tolerating his oral secretions.
46. • Only a trace amount of the trigger may be needed to
cause a severe reaction.
• Prescription and OTC medications.
• penicillin and NSAIDS most common
• Venom of stinging insects
• Foods, especially high-protein foods
• Transfusion of blood.
• Substances such as latex (natural rubber).
• Dyes and contrast materials used during radiologic
procedures or tests.
57. Obstructive shock has much in
common with cardiogenic shock
• Caused by mechanical
obstruction of blood
flow to and/or from the
heart
- something blocks
perfusion to the heart.
- Tension pneumothorax
- cardiac tamponade
- pulmonary embolism
Heart is working but there is a
block to the outflow
• Massive pulmonary embolism
• Aortic dissection
• Cardiac tamponade
• Tension pneumothorax
• Obstruction of venous return to
heart
• Vena cava syndrome - eg.
neoplasms, granulomatous
disease
• Sickle cell splenic sequestration
58.
59. Features of obstructive
shock
•Chest pain
• Dyspnoea
• Orthopnoea
•Cold, clammy peripheries
•Signs of specific aetiology, eg.
Muffled heart sound, unilateral
hyperresonant lung fields.
60. Features of obstructive
shock
• Heart rate = high
• Central venous pressure = high
• Systemic vascular resistance =
high
• Mixed venous O2sat = low
• Cardiac output = low
61. • Tension pneumothorax
• Increased pressure within the thoracic cavity blocks
the normal flow of blood to the heart
• Immediate relief by needle thoracotomy followed by
definitive tube thoracotomy.
• Cardiac tamponade
• Blood in the pericardium prevents blood from
entering the heart (venous return)
• perform a FAST scan, obtain urgent cardiothoracic
consult and prepare for pericardiocentesis
62. Pulmonary Embolism
A portion of a venous
clot breaks off, travels
through the venous
system through the
right side of the heart,
and subsequently
enters a pulmonary
66. Investigation - Lab
• If undetectable, it excludes
a diagnosis of PE
Serum d-
dimer
• low PaO2 and low SpO2
ABG
• Increase
ESR
• Increase
Serum LDH
67. Investigation - Imaging
• Radiological investigation of choice
• Blood clot appears as a filling defect in a contrast-
enhanced pulmonary artery. Sensitivity 90% and
specificity 95%
CT Pulmonary Artery of
Chest
• Normal or
classical findings of atelectasis, wedge shape lesio
n and pruning of pulmonary vessels
CXR
• Nonspecific (tachycardia) or
classical finding of S1, Q3, T3 and right strain p
attern including RBBB and RV hypertrophy
ECG
• Right side strain and in severe cases, blood clot
seen inside the RA, RV, RVOT and also in pulmonary
artery
Echocardiogram
• Homogeneous scintillation throughout the lung in
the perfusion portion rules out PE with 100%
sensitivity
V/Q scanning
• Performed to detect clot in pelvic or iliofemoral
veins
Compression US
68. CXR:
• Pleural effusion
• Cardiomegaly
• Atelectasis
• Hampton hump: shallow
wedge-shaped opacity in lung
periphery
• Westermark sign (in circle):
sharp pulmonary vessel with
distal hypoperfusion
• Palla’s sign (arrow): enlarged
right descending pulmonary
artery
69. Initial Management in ED
1. Utilize supplemental oxygen when
necessary to maintain adequate
pulse oximetry readings.
2. Administer intravenous crystalloid
fluids as needed to augment
preload and correct hypotension
3. Initiate initial anticoagulation
(LMWH favorable)
4. Systemic fibrinolytic therapy should
be considered for selected patients
with severe PE and no
contraindications.
70. Initial Management in ED
6. Surgical and suction thromboembolectomy
are options for patients with life-threatening
PE and contraindications to fibrinolysis. Open
surgical thromboembolectomy has high
mortality, but may be improved with early
and appropriate patient selection.
7. ICU admission when signs of circulatory
compromise are present or when
thrombolytic therapy is given and close
monitoring is needed
71. NONTRAUMATIC CARDIAC
TAMPONADE
• An increase in the amount of fluid within the
pericardial sac results in an increase in intrapericardial
pressure.
• The normal fibrocollagenous parietal pericardium has
elastic properties and stretches to accommodate
increases in intrapericardial fluid.
• If fluid continues to accumulate, intrapericardial
pressure rises to a level greater than that of the normal
filling pressures of the right heart chambers.
• When this occurs, ventricular filling is restricted and
results in cardiac tamponade.
72. Common Causes of Cardiac
Tamponade in Medical
(Nontrauma)Patients
73. Clinical Feature
• Symptoms are nonspecific, and patients most commonly complain of dyspnea at rest and with
exertion.
• Additional symptoms may be due to the underlying disease (e.g., uremia or tuberculous
pericarditis).
• Physical examination may reveal tachycardia and low systolic arterial blood pressure with a
narrow pulse pressure.
• Pulsus paradoxus may also be present. A paradoxical arterial pulse is said to be present when
the cardiac rhythm is regular and there are apparent dropped beats in the peripheral pulse
during inspiration.
• There is usually a<10 mm Hg decrease in systolic blood pressure during inspiration inthe
supine position.
• Pulsus paradoxus is not diagnostic of cardiac tamponade and may be noted in other
cardiopulmonary processes.
• In cardiac tamponade, the neck veins may be distended with an absent “y” descent.
• The apical impulse is indistinct or tapping in quality.
• Cardiac auscultation may reveal “distant” or soft heart sounds.
• Pulmonary rales are usually absent, and there may be right upper quadrant tenderness from
hepatic venous congestion.
74. Diagnosis
• The chest radiograph may or may not reveal an
enlarged cardiac silhouette because this finding
depends on the amount of intrapericardial fluid
accumulation.
• The ECG usually shows low-voltage QRS
complexes (<0.7 mV) and ST-segment
elevation (due to the inflammation of
the epicardium) with PR-segment
depression, as in pericarditis.
75. Echocardiography
• Diagnostic test of choice.
• In addition to a large pericardial fluid volume,
typical echocardiographic findings described in
cardiac tamponade:
• right atrial compression, RV diastolic collapse,
• abnormal respiratory variation in tricuspid and
mitral flow velocities
• dilated inferior vena cava with lack of inspiratory
collapse.
76. Treatment and Disposition
• Volume expansion with a bolus of normal saline
solution (500 to 1000 mL) will increase
intravascular volume, facilitate right heart filling,
and increase cardiac output and arterial pressure.
• However, it is a temporary measure.
• Pericardiocentesis is necessary for definitive
therapy and for specific diagnosis.
77. Tension Pneumothorax
• “one-way valve” air leak occurs
from the lung or through the chest
wall
• Air is forced into the pleural space
with no means of escape,
eventually collapsing the affected
lung
• mediastinum is displaced to the
opposite side, decreasing venous
return and compressing the
opposite lung
• Shock results from marked
decrease in venous return, causing
78.
79. Signs and symptoms
– Chest pain
– Air hunger
– Tachypnea
– Respiratory distress
– Tachycardia
– Hypotension
– Tracheal deviation away from the side
of the injury
– Unilateral absence of breath sounds
– Elevated hemithorax without
respiratory movement
– Neck vein distention
– Cyanosis (late manifestation)
80. Diagnosis
• Arterial saturation should be
assessed using a pulse oximeter
and will be decreased when
tension pneumothorax is present
• Tension pneumothorax can be
diagnosed using an extended
FAST (eFAST) examination.
81. Management
• Tension pneumothorax requires
immediate decompression and may
be managed initially by rapidly
inserting a large over-the-needle
catheter into the pleural space
• Tube thoracostomy is
mandatory after needle
or finger decompression
of the chest
https://www.youtube.com/wa
tch?v=zrUASl8onPY
82.
83. DEFINITION
•Major Brain or spinal injury
which distrupts brainstem
and neurogenic vasomotor
control.
• Davidson's Medicine
22nd edition
84. Neurogenic Shock
• It is a form of distributive shock
• Rarest form of shock
• Caused by sudden loss of sympathetic tone to
regions distal to the level of injury resulting in
vasodilation as well as restricting both reflex
tachycardia and vasoconstriction responses to
hypovolemia
85.
86. Occurs after acute spinal cord injury
Sympathetic outflow is disrupted leaving unopposed
vagal tone
Results in hypotension and bradycardia due to loss
of cardiac sympathetic tone.
Warm skin due to dilatation of peripheral blood vessels
Shock usually lasts from 1 to 3 weeks
Any injury above T1 can disrupt the entire
sympathetic system
• Higher injuries = worse paralysis
Neurogenic Shock
87. Other Investigation
CT of head/sinuses
Lumbar puncture
Wound cultures
Acute abdominal series
Abdominal/pelvic CT or US
Cortisol level
Fibrinogen, FDPs, D-dimer
88. Management
Intravenous Fluid : Large volumes may be needed to restore
normal hemodynamics but care should be taken not to
overload as it may precipitate pulmonary edema. Monitor the
urinary output with an indwelling urinary catheter.
Inotropic Support: Dopamine is often used
Atropine: Increase Heart Rate
Vasopressors: If hypotension remains refractory to treatment
**Urgent Orthopedic / Neurosurgical consult/ referal
89. The end point of resuscitation in
shock therapy
• There is no obvious end point to resuscitation as the process is dynamic.
The mainstay is to ensure the cause of shock is identified and manage
adequately or condition reversed or improved.
• The goal of trauma resuscitation and shock therapy is to ensure the ABCDE
is adequately managed and goals of resuscitation are achieved.
• Parameters to consider include:
• 1. Mental status improved
• 2. Vital signs normalized
• 3. Perfusion improved
• 4. A urine output of greater than 0.5 ml/kg/h
• 5. CVP reading of 8-12 mmHg
• 6. Mean Arterial pressure of 65-95 mmHg.
• 7. ABG improved
• 8. Lactate clearance.
90. Type of Shock Insult Physiologic Effect Compensation
Cardiogenic Heart fails to pump blood
out
↓CO BaroRc
↑SVR
Obstructive Heart pumps well, but the
outflow is obstructed
↓CO BaroRc
↑SVR
Hemorrhagic Heart pumps well, but not
enough blood volume to
pump
↓CO BaroRc
↑SVR
Distributive Heart pumps well, but
there is peripheral
vasodilation
↓SVR ↑CO