4. Cardiac output (CO) is the amount of blood pumped by
the heart minute
SVR is the resistance in the circulatory system that is used
to create blood pressure, the flow of blood and is also a
component of cardiac function. When blood vessels
constrict (vasoconstriction) this leads to an increase in
SVR.
end-diastolic volume (EDV) is the volume of blood in the
right or left ventricle at end of filling in diastole
Preload is the initial stretching of the cardiac myocytes
(muscle cells) prior to contraction. It is related to
ventricular filling.
Afterload is the force or load against which the heart has
to contract to eject the blood.
5. Shock : classification
Hypovolemic shock due to decreased
circulatory blood volume in relation to the
total vascular capacity and characterized
by reduction of preload and diastolic filling
pressure .
Cardiogenic shock due to cardiac pump
failure related to loss myocardial
contractility /functional myocardium or
mechanical failure of cardiac anatomy
and characterized by decreased systolic ,
diastolic function.
6. obstructive shock refers to the anatomical obstruction
of the great vessels of the heart (e.g., superior vena
cava, inferior vena cava, and pulmonary vessels) that
leads to decreased venous return and/or excessive
afterload (i.e., the force that the left ventricle has to
overcome to eject blood through the aortic valve),
resulting in decreased cardiac output.
Distributive shock also known as vasodilatory shock,
refers to systemic vasodilation and decreased blood
flow to vital organs such as the brain, heart, and
kidneys. It can also cause fluid to leak from the
capillaries into the surrounding tissues as a result.
-Septic shock (from a bacterial infection). ...
-Anaphylactic shock (from an allergic reaction or
asthma attack). ...
-Neurogenic shock (from a spinal cord injury that has
damaged your nervous system).
12. Management
Goals of management
Hemodynamic support MAP more than 60.
Maintain oxygen deliveryhemoglobin Hb more than 9 – arterial
saturation more than 92 %-supplemental oxygen and
mechanical ventilation .
Reversal of oxygen dysfunction decrease lactate less than 2.2
mML -maintain Urine Out Put – reverse encephalopathy –
improverenal function test and liver gunction tests .
13. Hypovolemic shock
Rapid replacement of blood , colloid ,or
crystalloid.
Identify source of blood or fluid loss .
Endoscopy colonoscopy .
Angiography .
CTMRI .
14. Cardiogenic shock
LV infarction : Intraaotic baloon pump , cardiac
angiography , Revascularization: angioplasty ,
coronary bypass.
RV infarction : fluids and inotropes with PA catheter
monitoring.
Mechanical abnormality : Echocardiography,
Cardiac Catheterization, Corrective Surgery.
Pericardial temponade :pericardiocentesis , surgical
drainage if needed.
Pulmonary Embolism : Heparin , Ventillation perfusion
lung scan , pulmonary angiography , thrombolytic
therapy or embolectomy at surgery .
15. Distributive shock ( septic shock ).
Depending on the cause of your distributive shock, your
provider willgive you the following medicines: Vasopressors
(epinephrine, vasopressin, norepinephrine or phenylephrine)
to raise your blood pressure. Antibiotics if there's an infection.
Antihistamines if you've had an allergic reaction
