1. Shock is defined as inadequate tissue perfusion due to failure of oxygen delivery, transport, or utilization, leading to cellular dysfunction.
2. The main types of shock are hypovolemic, traumatic, septic, and cardiogenic shock.
3. Treatment of shock involves identifying and treating the underlying cause, restoring circulating volume with intravenous fluids, and providing supportive care such as oxygen supplementation. Damage control resuscitation aims to correct the "lethal triad" of coagulopathy, acidosis, and hypothermia.
Ganesh is a 22 year old medical student who was in a car accident. He was found to be agitated and complaining of abdominal pain. At the scene, his vital signs showed elevated breathing and heart rate with low blood pressure. Upon arrival at the emergency room, his vital signs and physical exam showed signs of shock including a distended abdomen, cold hands and feet, and dark urine. His hemoglobin was low at 7, indicating blood loss and hypovolemic shock.
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 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.
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.
Sepsis is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues. Globally, sepsis kills about 8 million people annually. Early recognition and treatment are key to improving outcomes. The first hours after diagnosis are especially critical, as mortality increases by about 8% every hour that antibiotics are delayed. Prompt administration of broad-spectrum antibiotics and fluid resuscitation can significantly reduce mortality from sepsis.
Shock is a state of low tissue perfusion that impairs cellular respiration. It results from decreased blood flow caused by factors like blood loss, dehydration, heart issues, or infection. Left untreated, shock progresses through stages as the body's compensatory mechanisms fail. Types include hypovolemic, cardiogenic, obstructive, distributive, and neurogenic shock. Treatment focuses on identifying and treating the underlying cause while improving cardiac output and tissue perfusion through fluid resuscitation, oxygen supplementation, antibiotics for infection, and other interventions depending on the shock type. Monitoring includes vital signs, urine output, blood tests, and imaging to guide resuscitation goals like adequate blood pressure, urine output, and oxygen levels
This document provides an overview of shock, including its definition, pathophysiology, classification, severity, consequences if not treated, and guidelines for resuscitation and fluid therapy. Shock is defined as inadequate tissue perfusion for normal cellular respiration. The pathophysiology involves cellular hypoxia, microvascular injury, and systemic compensatory responses. Types of shock include hypovolemic, cardiogenic, obstructive, distributive, and endocrine. Later stages can lead to multi-organ failure if not treated properly. Fluid resuscitation should not be delayed but must consider the type and severity of shock. Monitoring is important during resuscitation to assess the response and guide further treatment.
Ganesh is a 22 year old medical student who was in a car accident. He was found to be agitated and complaining of abdominal pain. At the scene, his vital signs showed elevated breathing and heart rate with low blood pressure. Upon arrival at the emergency room, his vital signs and physical exam showed signs of shock including a distended abdomen, cold hands and feet, and dark urine. His hemoglobin was low at 7, indicating blood loss and hypovolemic shock.
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 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.
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.
Sepsis is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues. Globally, sepsis kills about 8 million people annually. Early recognition and treatment are key to improving outcomes. The first hours after diagnosis are especially critical, as mortality increases by about 8% every hour that antibiotics are delayed. Prompt administration of broad-spectrum antibiotics and fluid resuscitation can significantly reduce mortality from sepsis.
Shock is a state of low tissue perfusion that impairs cellular respiration. It results from decreased blood flow caused by factors like blood loss, dehydration, heart issues, or infection. Left untreated, shock progresses through stages as the body's compensatory mechanisms fail. Types include hypovolemic, cardiogenic, obstructive, distributive, and neurogenic shock. Treatment focuses on identifying and treating the underlying cause while improving cardiac output and tissue perfusion through fluid resuscitation, oxygen supplementation, antibiotics for infection, and other interventions depending on the shock type. Monitoring includes vital signs, urine output, blood tests, and imaging to guide resuscitation goals like adequate blood pressure, urine output, and oxygen levels
This document provides an overview of shock, including its definition, pathophysiology, classification, severity, consequences if not treated, and guidelines for resuscitation and fluid therapy. Shock is defined as inadequate tissue perfusion for normal cellular respiration. The pathophysiology involves cellular hypoxia, microvascular injury, and systemic compensatory responses. Types of shock include hypovolemic, cardiogenic, obstructive, distributive, and endocrine. Later stages can lead to multi-organ failure if not treated properly. Fluid resuscitation should not be delayed but must consider the type and severity of shock. Monitoring is important during resuscitation to assess the response and guide further treatment.
Shock is a life-threatening condition defined as inadequate tissue perfusion and cellular respiration. The document discusses the pathophysiology, classification, signs, and management of shock. Shock can be caused by hemorrhage, sepsis, anaphylaxis, or trauma. Early recognition and treatment is critical to prevent multiple organ failure and death. Fluid resuscitation is initially used but controlling any hemorrhage is paramount to recovery. Monitoring for signs of persistent or worsening shock is also important.
The document discusses shock, including its pathophysiology, classification, severity, consequences, and resuscitation. It aims to provide medical students an understanding of shock. Shock is defined as a systemic state of low tissue perfusion inadequate for cellular respiration. Different types of shock are classified including hypovolemic, cardiogenic, obstructive, distributive, and endocrine shock. The severity of shock ranges from compensated to decompensated to multiple organ failure. Consequences include cellular damage, organ dysfunction, and death. Resuscitation focuses first on fluid therapy and addressing hypovolemia, with vasopressors and inotropes as adjuncts depending on the shock type.
Pathophysiology of shock and its managementBipulBorthakur
This document discusses different types of shock including distributive, cardiogenic, obstructive, hypovolemic, and stages of shock. It provides details on sepsis and septic shock including pathogenesis, diagnostic criteria, and elements of care. Specific types of shock like neurogenic shock, anaphylactic shock, and cardiogenic shock are also summarized. The document emphasizes early recognition and treatment of shock.
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 a life-threatening condition where tissue perfusion is insufficient to meet oxygen and nutrient demands. This results from decreased blood flow that can damage organs rapidly. There are four main types of shock: hypovolemic from fluid loss; cardiogenic from heart failure; distributive from vasodilation; and obstructive from blood flow obstruction. Treatment focuses on fluid resuscitation, vasopressors, antibiotics for infection, and treating the underlying cause to improve perfusion before organ damage becomes irreversible.
This document summarizes shock in children, including the different types (hypovolemic, cardiogenic, obstructive, distributive, and septic), signs, symptoms, pathophysiology, diagnosis, and treatment for each type. The main types of shock are defined as hypovolemic (decreased blood volume), cardiogenic (poor cardiac contractility), distributive (inadequate vasomotor tone), obstructive (restriction of cardiac chambers), and septic (complex interaction of multiple types of shock due to infection). Clinical manifestations include tachycardia, tachypnea, decreased urine output, and altered mental status. Treatment involves restoring circulating volume and tissue perfusion, treating the underlying cause, and using
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.
This document discusses haemorrhage and shock. It defines haemorrhage as bleeding from damaged blood vessels, and classifies it based on site, vessel type, timing, and intervention needed. Shock is defined as insufficient oxygen delivery to tissues. The document outlines signs of haemorrhage and shock, degrees of blood loss, measurement methods, and management approaches including fluid resuscitation and hemostatic measures. It also describes types of shock including hypovolemic, septic and cardiogenic shock, and their pathogenesis. Treatment of shock focuses on stabilization, IV fluids, and vasopressor drugs. Complications in organs like heart, lungs, and liver are also summarized.
This document provides a summary of key points regarding sepsis epidemiology, pathophysiology, diagnosis, and treatment. It discusses:
1) Sepsis is a leading cause of death in hospitals, with over 200,000 deaths per year in the US. Early goal directed therapy focusing on initial fluid resuscitation and hemodynamic support can reduce mortality.
2) The sepsis cascade involves a systemic inflammatory response that can progress to organ dysfunction and shock if not treated promptly. Global tissue hypoxia is a key indicator preceding multiple organ failure.
3) Early recognition and treatment is important, with antibiotics, fluid resuscitation, and hemodynamic support through vasopressors and inotropes if needed to
Critical Care Nurse Student | Assistant Clinical Researcher | Chairperson National Nurses of Kenya-Siaya Branch | Mentor | SRHR & Boys Advocate.
Young and energetic healthcare professional with a strong belief in the basic tenets of human development and quality of life. My key qualities include integrity, hardworking, team player and keenness to achieve results.
The document discusses pharyngeal arches, which consist of pharyngeal arches, clefts, and pouches during the 4th week of development. The mesoderm and neural crest cells of the pharyngeal arches give rise to cartilage, bone, connective tissue, muscles, nerves, and arteries. The first pharyngeal arch derivatives include the maxilla and mandible.
Hemorrhagic shock occurs due to heavy blood loss, which reduces tissue perfusion and oxygen delivery. It is defined as inadequate oxygen delivery to tissues due to reduced circulating blood volume and oxygen-carrying capacity. Common causes are trauma, gastrointestinal bleeding, and obstetrical bleeding. Signs and symptoms include low blood pressure, rapid heart rate, confusion, and loss of consciousness as organs are deprived of oxygen. Diagnostic evaluation includes physical examination, imaging studies, and laboratory tests. Management focuses on restoring circulating volume through fluid replacement, blood transfusion, and vasopressor medications to maintain adequate blood pressure and oxygen delivery to tissues in order to prevent multiple organ failure and death.
The document discusses different types of shock including their causes, pathogenesis, and management. It defines shock as an imbalance between oxygen supply and demand resulting in organ dysfunction. The main types are distributive, cardiogenic, obstructive, and hypovolemic shock. Septic shock is discussed in depth including its pathogenesis involving an inflammatory response to infection, diagnostic criteria using SOFA and qSOFA scores, and elements of care including resuscitation, infection control, and supportive therapies. Cardiogenic shock is defined as a low cardiac output state resulting from various cardiac causes such as myocardial infarction. Hypovolemic shock reduces cardiac output through a decrease in preload from losses such as hemorrhage.
Haemorrhagic shock results from hypovolemia due to blood loss, leading to decreased preload and increased sympathetic activity. This causes vasoconstriction and decreased blood pressure, resulting in ischemia and eventual multi-organ failure. Classification of hemorrhagic shock ranges from 15-40% blood loss with compensated mechanisms maintaining blood pressure initially, but ultimately leading to uncompensated shock. Management focuses on controlling hemorrhage, fluid resuscitation, and blood transfusion to restore volume. Massive blood transfusion is loosely defined as over 10 units in 24 hours or 50% blood volume replacement in 12 hours, with general indications being hemorrhagic shock and anemia in critical illness.
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 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
The patient is in uncompensated/hypotensive shock based on increased heart rate, cool extremities with prolonged capillary refill, and hypotension. The shock is likely hypovolemic due to fluid loss from the gunshot wounds and surgery. The initial management should be rapid fluid resuscitation with isotonic fluids to restore circulating volume and tissue perfusion.
1) Shock is characterized by decreased tissue perfusion and cellular metabolism due to an imbalance between oxygen supply and demand. It can be classified as low blood flow shock (cardiogenic, hypovolemic) or maldistribution of blood flow shock (septic, anaphylactic, neurogenic).
2) Management of shock involves identifying the cause, restoring circulating volume through fluid resuscitation, supporting vital organ function, and treating the underlying cause. General management strategies include ensuring a patent airway, maximizing oxygen delivery, and volume expansion with isotonic crystalloids.
3) The stages of shock include initial, compensated, progressive, and refractory. Treatment aims to support compensation and prevent progression
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
Shock is a life-threatening condition defined as inadequate tissue perfusion and cellular respiration. The document discusses the pathophysiology, classification, signs, and management of shock. Shock can be caused by hemorrhage, sepsis, anaphylaxis, or trauma. Early recognition and treatment is critical to prevent multiple organ failure and death. Fluid resuscitation is initially used but controlling any hemorrhage is paramount to recovery. Monitoring for signs of persistent or worsening shock is also important.
The document discusses shock, including its pathophysiology, classification, severity, consequences, and resuscitation. It aims to provide medical students an understanding of shock. Shock is defined as a systemic state of low tissue perfusion inadequate for cellular respiration. Different types of shock are classified including hypovolemic, cardiogenic, obstructive, distributive, and endocrine shock. The severity of shock ranges from compensated to decompensated to multiple organ failure. Consequences include cellular damage, organ dysfunction, and death. Resuscitation focuses first on fluid therapy and addressing hypovolemia, with vasopressors and inotropes as adjuncts depending on the shock type.
Pathophysiology of shock and its managementBipulBorthakur
This document discusses different types of shock including distributive, cardiogenic, obstructive, hypovolemic, and stages of shock. It provides details on sepsis and septic shock including pathogenesis, diagnostic criteria, and elements of care. Specific types of shock like neurogenic shock, anaphylactic shock, and cardiogenic shock are also summarized. The document emphasizes early recognition and treatment of shock.
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 a life-threatening condition where tissue perfusion is insufficient to meet oxygen and nutrient demands. This results from decreased blood flow that can damage organs rapidly. There are four main types of shock: hypovolemic from fluid loss; cardiogenic from heart failure; distributive from vasodilation; and obstructive from blood flow obstruction. Treatment focuses on fluid resuscitation, vasopressors, antibiotics for infection, and treating the underlying cause to improve perfusion before organ damage becomes irreversible.
This document summarizes shock in children, including the different types (hypovolemic, cardiogenic, obstructive, distributive, and septic), signs, symptoms, pathophysiology, diagnosis, and treatment for each type. The main types of shock are defined as hypovolemic (decreased blood volume), cardiogenic (poor cardiac contractility), distributive (inadequate vasomotor tone), obstructive (restriction of cardiac chambers), and septic (complex interaction of multiple types of shock due to infection). Clinical manifestations include tachycardia, tachypnea, decreased urine output, and altered mental status. Treatment involves restoring circulating volume and tissue perfusion, treating the underlying cause, and using
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.
This document discusses haemorrhage and shock. It defines haemorrhage as bleeding from damaged blood vessels, and classifies it based on site, vessel type, timing, and intervention needed. Shock is defined as insufficient oxygen delivery to tissues. The document outlines signs of haemorrhage and shock, degrees of blood loss, measurement methods, and management approaches including fluid resuscitation and hemostatic measures. It also describes types of shock including hypovolemic, septic and cardiogenic shock, and their pathogenesis. Treatment of shock focuses on stabilization, IV fluids, and vasopressor drugs. Complications in organs like heart, lungs, and liver are also summarized.
This document provides a summary of key points regarding sepsis epidemiology, pathophysiology, diagnosis, and treatment. It discusses:
1) Sepsis is a leading cause of death in hospitals, with over 200,000 deaths per year in the US. Early goal directed therapy focusing on initial fluid resuscitation and hemodynamic support can reduce mortality.
2) The sepsis cascade involves a systemic inflammatory response that can progress to organ dysfunction and shock if not treated promptly. Global tissue hypoxia is a key indicator preceding multiple organ failure.
3) Early recognition and treatment is important, with antibiotics, fluid resuscitation, and hemodynamic support through vasopressors and inotropes if needed to
Critical Care Nurse Student | Assistant Clinical Researcher | Chairperson National Nurses of Kenya-Siaya Branch | Mentor | SRHR & Boys Advocate.
Young and energetic healthcare professional with a strong belief in the basic tenets of human development and quality of life. My key qualities include integrity, hardworking, team player and keenness to achieve results.
The document discusses pharyngeal arches, which consist of pharyngeal arches, clefts, and pouches during the 4th week of development. The mesoderm and neural crest cells of the pharyngeal arches give rise to cartilage, bone, connective tissue, muscles, nerves, and arteries. The first pharyngeal arch derivatives include the maxilla and mandible.
Hemorrhagic shock occurs due to heavy blood loss, which reduces tissue perfusion and oxygen delivery. It is defined as inadequate oxygen delivery to tissues due to reduced circulating blood volume and oxygen-carrying capacity. Common causes are trauma, gastrointestinal bleeding, and obstetrical bleeding. Signs and symptoms include low blood pressure, rapid heart rate, confusion, and loss of consciousness as organs are deprived of oxygen. Diagnostic evaluation includes physical examination, imaging studies, and laboratory tests. Management focuses on restoring circulating volume through fluid replacement, blood transfusion, and vasopressor medications to maintain adequate blood pressure and oxygen delivery to tissues in order to prevent multiple organ failure and death.
The document discusses different types of shock including their causes, pathogenesis, and management. It defines shock as an imbalance between oxygen supply and demand resulting in organ dysfunction. The main types are distributive, cardiogenic, obstructive, and hypovolemic shock. Septic shock is discussed in depth including its pathogenesis involving an inflammatory response to infection, diagnostic criteria using SOFA and qSOFA scores, and elements of care including resuscitation, infection control, and supportive therapies. Cardiogenic shock is defined as a low cardiac output state resulting from various cardiac causes such as myocardial infarction. Hypovolemic shock reduces cardiac output through a decrease in preload from losses such as hemorrhage.
Haemorrhagic shock results from hypovolemia due to blood loss, leading to decreased preload and increased sympathetic activity. This causes vasoconstriction and decreased blood pressure, resulting in ischemia and eventual multi-organ failure. Classification of hemorrhagic shock ranges from 15-40% blood loss with compensated mechanisms maintaining blood pressure initially, but ultimately leading to uncompensated shock. Management focuses on controlling hemorrhage, fluid resuscitation, and blood transfusion to restore volume. Massive blood transfusion is loosely defined as over 10 units in 24 hours or 50% blood volume replacement in 12 hours, with general indications being hemorrhagic shock and anemia in critical illness.
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 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
The patient is in uncompensated/hypotensive shock based on increased heart rate, cool extremities with prolonged capillary refill, and hypotension. The shock is likely hypovolemic due to fluid loss from the gunshot wounds and surgery. The initial management should be rapid fluid resuscitation with isotonic fluids to restore circulating volume and tissue perfusion.
1) Shock is characterized by decreased tissue perfusion and cellular metabolism due to an imbalance between oxygen supply and demand. It can be classified as low blood flow shock (cardiogenic, hypovolemic) or maldistribution of blood flow shock (septic, anaphylactic, neurogenic).
2) Management of shock involves identifying the cause, restoring circulating volume through fluid resuscitation, supporting vital organ function, and treating the underlying cause. General management strategies include ensuring a patent airway, maximizing oxygen delivery, and volume expansion with isotonic crystalloids.
3) The stages of shock include initial, compensated, progressive, and refractory. Treatment aims to support compensation and prevent progression
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
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.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
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.
4. Introduction
• Hipocrates and Cannon use the word ‘exemia’ to
describe shock
• Initially the word shock was used to refer to the
physical effect of wounding agent not the
physiologic respone
• Dr. George crile, vasomotor changes resulting from
nervous stimulation played an important role in the
pathophysiology of shock
• Blalock, the different classification of shock
5. Definition
• Inadequate tissue perfusion marked by decreased
delivery of required metabolic substrates and
inadequate removal of cellular waste products.
• This involves failure of oxidative metabolism that
can involve defects of oxygen (O2) delivery,
transport, and/or utilization.
6. Pathophysiology
I. Cellular
• As perfusion to the tissues is reduced, cells are
deprived of oxygen and must switch from aerobic to
anaerobic metabolism.
• The product of anaerobic respiration is not carbon
dioxide but lactic acid.
• When enough tissue is under perfused, the
accumulation of lactic acid in the blood produces
systemic metabolic acidosis.
7. Contd..
Microvascular
• As tissue ischemia progresses, changes in the local
milieu result in activation of the immune and
coagulation systems.
• Hypoxia and acidosis activate complement and prime
neutrophils, resulting in the generation of oxygen free
radicals and cytokine release.
• These mechanisms lead to injury of the capillary
endothelial cells.
8. Contd..
Systemic
Cardiovascular
• As preload and afterload decrease there is a
compensatory baroreceptor response resulting in
increased sympathetic activity and release of
catecholamines into the circulation.
• This results in tachycardia and systemic
vasoconstriction.
9. Contd..
Respiratory
• The metabolic acidosis and increased sympathetic
response result in an increased respiratory rate and
minute ventilation to increase the excretion of carbon
dioxide.
Renal
• Decreased perfusion pressure in the kidney leads to
reduced filtration at the glomerulus and a decreased
urine output.
10. Contd..
• The renin–angiotensin–aldosterone axis is stimulated
resulting in further vasoconstriction and increased
sodium and water reabsorption by the kidney.
Endocrine
• Cortisol is also released from the adrenal cortex,
contributing to the sodium and water reabsorption and
sensitizing the cells to catecholamine.
11. Phases of shock
The pathophysiologic responses vary with
time and in response to resuscitation
The compensated phase
the decompensated phase
The irreversible phase
13. Decompensated phase
• Continued hypo perfusion
• Early manifestation; cellular/tissue level
Cellular injury and death
Microcirculatory dysfunction, parenchymal tissue
damage, and inflammatory cell activation
• Late manifestations: organ system level
14. Irreversible phase
• Persistent hypo perfusion resulting in further
hemodynamic derangements and cardiovascular
collapse
• At this point, extensive parenchymal and
microvascular injury has occurred
• Volume resuscitation fails to reverse the process
19. Hypovolemic/Hemorrhagic shock
• Cause of shock in a trauma or postoperative patient
• Potential sites of blood loss:
External loss
Internal/intracavitary loss
Ribs….each, 100 to 200ml
Pelvic…2000ml or more
Femur…800 to 1000ml
Tibia#...300 to 500ml
23. Clinical signs of shock
Agitation
cool clammy extremities
Tachycardia, weak or absent peripheral pulses, and
hypotension.
25 to 30% of blood volume loss needed for this
manifestations
24. Shock index
• Designed to improve early detection and severity
• More sensitive in prediction of hypotension, the
need for massive transfusion
• SI = HR / Systolic BP (mmHg)
• Normal shock index is 0.5-0.7
• Has prognostic value
28. Hypotension of ⩽110 mmHg is Associated with Increased Mortality in
South African Patients After Trauma
29. Contd..
Hct:
• has been shown to be associated with 24 hour fluid
and transfusion requirements
• Normal hematocrit doesn't rule out significant
blood loss or ongoing bleeding
30. Treatment
• Shout for help
• ABCDE of life
• Open double large bore IV catheter
• Take 10ml of blood sample during iv line
for CBC , BG & Rh and cross match
• Shock position
• Intranasal O2
• Bladder catheterization for fluid balance
• Resuscitation with iv fluid
• Preparing blood
• Detect the cause and arrest hemorrhage
31. Initial management of
hemorrhage
• Control external bleeding
• Initiate resuscitation
IV fluids should be used only for hypotensive
patients, till blood is available
Blood products should be given in equivalent
amount
If available dynamic coagulopathy measuring
methods should guide resuscitation
33. Iv fluid resuscitation
• Subject of debate
• 500ml NS bolus via 18G Iv cannula as fast as
possible
• Repeat till blood is available or BP is greater than or
equal to 90mm Hg, or MAP of 65mm Hg or more
• Hypertonic saline…needs further investigations
• Colloids, has no improved outcome, and expensive
34. Massive transfusion protocol
• Traditionally, 10 units of PRBCs or more transfused
over 24hr
• 10 units or more transfused over 6 hours
• For patients with severe ongoing hemorrhage
35. ABC score for MTP
1. Penetrating mechanism of injury
2. Positive FAST
3. SBP of 90 mmHg or less
4. Heart rate of 120 beats per minute (bpm) or
greater
• Each with score of one.
• a sore of 2 or more has 75% sens and 86% spes for
need for mssive transfusion
36. Damage control resuscitation
• DCR is a systematic approach to the management
of the trauma patient
• Starts in the ER, OR and the ICU
• DCR involves homeostatic resuscitation, permissive
hypotension (where appropriate) and DCS
• Aim is correct the ‘lethal triad’ till definitive
intervention is appropriate
37. Permissive hypotension
• Refers to restricting the amount of resuscitation
fluid and maintaining blood pressure in the lower
than normal range
• Avoid dilusional coagulopathy and acceleration of
hemorrhage,
but does carry the potential risk of tissue
hypoperfusion.
38. DCS
• Previously called abbreviated laparotomy
• It is an operative intervention to treat immediately
life threatening condition
• Short procedure done on a patient with limited
physiologic reserve
39. Phases of DCR
• Phase 0…triage and patient transport
• Phase 1
Arresting hemorrhage, limiting contamination and
maintaining optimal blood flow to vital organs
caution…operating time should be limited
• Phase 2 and 4
40. Contd..
3.Large volume of resuscitation required
4. Injury pattern identified during surgery
5. Need for staged abdominal or thoracic
reconstruction
42. Contd..
Signs of normovolaemia being re-established
• Improvement in urine output, HR, BP
• Fast capillary refill
• Return of peripheral pulses
• Improving consciousness level
• Normalizing in arterial PH
• Rise In CVP
43. Adjuncts of therapy
• Tranexamic acid
• Inotropes
• Hypothermia mt
• Oxygen and ventilator support
• Positioning
44. Tranexemic acid
• Tranexamic acid is an IV antifibrinolytic drug
that may be used for the prevention and
treatment of hemorrhage.
• Preparation, 1g/10ml
• administration:
1ml per minute over 10 minutes
Repeat same dose If bleeding persists within 30min
or with in 24hr of first dose
It is effective if given with in 3hr of trauma
46. Traumatic Shock
• Systemic response after trauma
• Due to combined effect of hemorrhage, soft tissue
injury and long bone fractures
• Results in ARDS and multiorgan failure
48. Treatment
• prompt control of hemorrhage
• Adequate volume resuscitation to correct O2 debt
• Debridement of nonviable tissue
• stabilization of bony injuries
• Appropriate treatment of soft tissue injuries
49. Septic Shock (Vasodilatory Shock)
• Dysfunction of the endothelium and vasculature
• 2o to circulating inflammatory mediators or due to
persistent hypoperfusion.
• Hypotension is due to vascular smooth MUSCLE
dysfunction
• Characterized by fever, increased CO, micro blood
clot formation, sludging of blood
50.
51. Pathophysiology
Microorganism or products of damage tissue
stimulate production of pro inflammatory cytokines
which in turn stimulate production of secondary
meditators of inflammation
Normally this mediators are regulated to limit
damage
In sepsis and extensive tissue damage this
regulation fails and results in excessive
inflammatory response which then leads to tissue
injury
53. Diagnosis
SIRS: 2 or more of…
Sepsis: infection ➕ SIRS
severe sepsis: sepsis ➕ signs of organ dysfunction
Septic shock: severe sepsis which doesn't respond
to fluid resuscitation and which requires
vasopressors or inotropic agents.
SOFA score and qSOFA
54. Approach to sepsis and septic
shock mt
• ABC of life
• Antibiotics
• Source control
• Intubation and ventilation
• Fluid resuscitation, at least 30 mL/kg for
hypotensive patients
• Serum lactate determination
56. Contd..
A. Stabilize the airway
Oxygen with conscious pulse oximetry monitoring
Intubation and MV, if depressed mentation or
increased work of breathing
B. Establish venous access
Peripheral or central
Start fluids, antibiotics and vasopressor
57. Contd..
C. Initial investigations
• CBC and urinalysis
• ABGs analysis
• Serum lactate
• OFT
• Targeted imaging
• Blood culture, aerobic and anaerobic from at least
two different sites
• Microbiologic culture
58. Contd..
D. Initial resuscitative therapy
• Iv fluids and the early administration of antibiotics
• Crystalloids given at a rate of 30ml/kg over 3hr
• Fluid choice?
• Monitor BP, chest condition and tissue perfusion
• Empiric antibiotics started with in 1hr
59. Contd..
Empiric antibiotic therapy (first hour)
• Identification of suspected source
• Timing
• Choosing a regimen
Previous exposure, comorbidity, immune defect,
site of infection, local resistance, hospitalization
hx….
60. Contd..
if Pseudomonas is an unlikely pathogen, we favor
combining vancomycin plus
•Cephalosporin, 3rd gnrn
(eg, ceftriaxone or cefotaxime) or 4th generation
(cefepime), or
•Beta-lactam/beta-lactamase inhibitor
(eg, piperacillin-tazobactam, ticarcillin-clavulanate),
or
•Carbapenem (eg, imipenem or meropenem)
61. Contd..
• Pseudomonas is a likely pathogen, vanco. plus
• Antipseudomonal cephalosporin, or
•Antipseudomonal carbapenem, or
•Antipseudomonal beta-lactam/beta-
lactamase inhibitor, or
•Fluoroquinolone with good anti-pseudomonal
activity, or
•Aminoglycoside, or
•Monobactam (eg, aztreonam)
66. Source control
• IV antibiotics will be insufficient for the ff
Infected fluid collections
Infected foreign bodies
Devitalized tissue
Tx: percutaneous drainage and operative mt
67. Next step after initial therapy
• Identification and source control
• De escalation of fluids
• De escalation and duration of abs
70. Vasopressors
• If fluid resuscitation failed to maintainBP
• Norepinephrine is first line
• If not available adrenaline
• Arginine vasopressor for catecholamine resistant
septic shock
• Doubutmine for those with low cardiac output
71. Cardiogenic shock
• Circulatory pump failure leading to diminished
forward flow and subsequent tissue hypoxia,
• In the setting of adequate intravascular volume.
77. Treatments
• Ensuring adequate oxygenation and O2
delivery
• Maintaining adequate preload with judicious
volume restoration
• Minimizing sympathetic discharge through
adequate relief of pain
• Correcting electrolyte imbalance
78. Treatment…
• Intubation and MV
• Judicious fluid resuscitation
• Correct electrolyte abnormality
• Potent analgesics
• Mt of dysrhythmia
• Inotropic agents
• Intra aortic balloon pump
79. Inotropic agents
• Doubutamine
• Dopamine esp. for hypotensive patients
• Epinephrine; tachycardia and vasoconstriction
For refractory cardiogenic shock
phosphodiesterase inhibitors amrinone and
milrinone can be used
80. Treatment…
An intra-aortic balloon pump
a bedside procedure in the ICU
Via the femoral artery through either a cut down or
using the percutaneous approach.
81. Treatment…
Percutaneous transluminal coronary angiography
• Cardiogenic shock with:
1. acute STEMI suggesting 100% occlusion of
the coronary artery
2. Left bundle branch block
Age should be less than 75yr
83. Other adjuncts of therapy
• Beta blockers
• Nitrites
• ACE inhibitors
84. Obstructive shock
• Due to mechanical obstruction of venous return
• Tension pneumothorax is commonest cause
•
85. Diagnosis and treatment
• Tension Pneumothorax
Dx:
Clinical; respiratory distress (in an awake patient),
hypotension, diminished breath sounds,
hyperresonance to percussion, jugular venous
distention….3 signs enough for dx
Chest X ray
deviation of mediastinal structures, depression of the
hemidiaphragm, and hypo-opacification with absent
lung markings
87. Contd..
• Cardiac tamponade
Beck’s triad consists of hypotension, muffled heart
tones, and neck vein distention
Absence doesn't exclude
Others: dyspnea, orthopnea, cough, peripheral edema,
chest pain, tachycardia
Invasive hemodynamic monitoring; pulsus-paradoxus,
elevated right atrial and ventricular pressure
88. Contd..
• ECG
• Echo
• Pericardiocentesis
• Diagnostic pericardial window, two approaches
Tx: Left thoracotomy
89. Neurogenic shock
• Diminished tissue perfusion as a result of loss of
vasomotor tone to peripheral arterial beds
• Loss of vasoconstrictor impulses results in
increased VC, decreased VR, and decreased CO
• 2o to high spinal cord segment injury
•
90. Pathophysiology
• spinal cord injury leads to multiple secondary injury
mechanisms:
vascular compromise: loss of autoregulation,
vasospasm, and thrombosis
loss of cellular membrane integrity and impaired
energy metabolism
neurotransmitter accumulation and release of free
radicals.
91. Diagnosis
• Bradycardia, hypotension, cardiac dysrhythmias,
reduced cardiac output, and decreased peripheral
vascular resistance.
• Warm extremities, motor and sensory deficits
indicative of a spinal cord injury, and radiographic
evidence of a vertebral column fracture
92. Treatment
• Secure airway
• Resuscitate with crystalloid
• Vasopressors…dopamine or phenylephrine
Note: life-threatening cardiac dysrhythmias and
hypotension may occur up to 14 days after spinal
cord injury
94. References
1. Schwartz principles of surgery, 11th edn
2. Sabiston text book of surgery, 21st edn
3. Guyton and Hall text book of medical physiology,12th edn
4. WHO, The clinical use of blood, 2002
5. Uptodate, 2018
6. Does Tachycardia Correlate with Hypotension After Trauma?
Victorino, Gregory P MD, Battistella, Felix D MD, FACS; Wisner, David H
MD, FACS
7. Hypotension of ⩽110 mmHg is Associated with Increased
Mortality in South African Patients After Trauma D L Clarke , P
Brysiewicz , B Sartorius , J L Bruce, G L Laing
8. Tranexamic acid in bleeding trauma patients: an exploration of benefits
and harms Ian Roberts, Phil Edwards, David Prieto, Miland Joshi, Abda
Mahmood, Katharine Ker & Haleema