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SHOCK

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SHOCK DEFINITION Profound hemodyamic and metabolic disturbance characterized by failure of the circulatory system to maintain adequate perfusion of vital organs Types ... – PowerPoint PPT presentation

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Title: SHOCK


1
SHOCK
2
DEFINITION
  • Profound hemodyamic and metabolic disturbance
    characterized by failure of the circulatory
    system to maintain adequate perfusion of vital
    organs

3
Types of Shock
  • Cardiogenic (intracardiac vs extracardiac)
  • Hypovolemic
  • Distributive
  • sepsis
  • neurogenic (spinal shock)
  • adrenal insufficiency
  • anaphylaxis

4
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5
Cardiogenic Shock, intracardiac
  • Myocardial Injury or Obstruction to Flow
  • Arrythymias
  • valvular lesions
  • AMI
  • Severe CHF
  • VSD
  • Hypertrophic Cardiomyopathy

6
Presentation of Cardiogenic Shock
  • Pulmonary Edema
  • JVD
  • hypotensive
  • weak pulses
  • oliguria

7
Cardiogenic Shock, extracardiac(Obstructive)
  • Pulmonary Embolism
  • Cardiac Tamponade
  • Tension Pneumothorax
  • Presentation will be according to underlying
    disease process.

8
Hypovolemic Shock
  • Reduced circulating blood volume with secondary
    decreased cardiac output
  • Acute hemorrhage
  • Vomiting/Diarrhea
  • Dehydration
  • Burns
  • Peritonitis/Pancreatitis

9
Presentation of Hypovolemic Shock
  • Hypotensive
  • flat neck veins
  • clear lungs
  • cool, cyanotic extremities
  • evidence of bleeding?
  • Anticoagulant use
  • trauma, bruising
  • oliguria

10
Distributive Shock
  • Peripheral Vasodilation secondary to disruption
    of cellular metabolism by the effects of
    inflammatory mediators.
  • Gram negative or other overwhelming infection.
  • Results in decreased Peripheral Vascular
    Resistance.

11
Distributive Shock Presentation
  • Febrile
  • Tachycardic
  • clear lungs, evidence of pneumonia
  • warm extremities
  • flat neck veins
  • oliguria

12
Diagnosing Shock
  • Response to fluids
  • Echo/EKG
  • CXR
  • Evidence of infection
  • Swan-Ganz Catheter?

13
Swan-Ganz Catheter
  • Utilized to differentiate types of shock and
    assist in treatment response.
  • Probably overused by physicians. Studies
    documenting increased mortality in patients with
    catheters versus no catheters, although somewhat
    swayed by selection bias.

14
Swan-Ganz Catheter
15
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16
Swan-Ganz Interpretation
17
Management
  • Correct underlying disorder if possible and then
    direct efforts at increasing the blood pressure
    to increase oxygen delivery to the tissues.
  • Maintain a mean arterial pressure of 60 (1/3
    systolic 2/3 diastolic)
  • Keep O2 sats gt92, intubate if neccesary

18
Correction of hypotension
  • Normal Saline should be administered anytime a
    patient is hypotensive. If hypotension exists
    give more NS.
  • If possible give blood as it replaces colloid.
  • Vasopressors
  • Inotropic agents for cardiogenic shock
  • Intra-aortic Balloon Pump for cardiogenic

19
Autonomic Drugs in Shock
20
Management of Cardiogenic Shock
  • Attempt to correct problem and increase cardiac
    output by diuresing and providing inotropic
    support. IABP is utilized if medical therapy is
    ineffective. Catheterization if ongoing ischemia
  • Cardiogenic shock is the exception to the rule
    that NS is always given for hypotension NS will
    exacerbate cardiac shock.

21
Intra-Aortic Balloon Pump
22
Management of Septic Shock
  • Early goal directed therapy
  • Identification of source of infection
  • Broad Spectrum Antibiotics
  • IV fluids
  • Vasopressors
  • Steroids ??
  • Recombinant human activated protein C ( Xygris)
  • Bicarbonate if pH lt 7.1

23
Management of Hypovolemic Shock
  • Correct bleeding abnormality
  • If PT or PTT elevated then FFP
  • Aggressive Fluid replacement with 2 large bore
    IVs or central line.
  • Pressors are last line, but commonly required.

24
Addisons Disease
  • Deficiency of cortisol and aldosterone production
    in the adrenal glands
  • This is suspected when patient is non-responsive
    to fluids and antibiotics.
  • Electrolytes may reveal hyponatremia and
    hyperkalemia
  • Hydrocortisone 100 mg IV immediately then taper
    appropriately
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