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power point presentation on shock management.pptx

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Shock is a medical emergency characterized by inadequate tissue perfusion leading to cellular dysfunction. It can be caused by issues related to blood volume, cardiac function, vasodilation, or obstruction of blood flow. The main goals in treatment are to restore circulating volume and tissue perfusion through intravenous fluids, blood products, vasopressors if needed, and treating the underlying cause. Early recognition and treatment are important to prevent multiple organ failure and death.

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power point presentation on shock management.pptx
Definition & mechanism of shock. Consequences of Shock. How to diagnose shock? Classification of Shock. Causes of various types of shock Basic principles in management of shock.
Shock is reduction of effective tissue perfusion leading to cellular and circulatory dysfunction It is a medical emergency, if unrecognized or inadequately treated will result in high mortality
Reduced Perfusion Brain Decreased mental status Myocardial Depression Kidney Oliguria Liver Increased liver enzymes Lung Hypoxemia Pheripheral Circulation Hypotension Heart
The aim of perfusion is to achieve adequate Cellular Oxygenation This requires Red Cell Red Cell Oxygenation Delivery To Tissues
Red Cell Oxygenation 1. Oxygen delivery to alveoli Adequate FiO2 Patent airways Adequate ventilation
2. Oxygen exchange with blood Adequate oxygen diffusion into blood Adequate RBC capacity to bind O2 pH Temperature
Red Cell Delivery To Tissues 1. Adequate perfusion Blood volume Cardiac output Heart rate Stroke volume Conductance Arterial resistance Venous capacitance
2. Adequate Hgb Adequate Hgb levels Adequate RBC capacity to bind O2 pH Temperature
Inadequate tissue perfusion: Poor cellular Shift from aerobic Oxygenation to anaerobic metabolism
GLUCOSE METABOLISM 2 LACTIC ACID 2 ATP HEAT (32 kcal) Glycolysis: Inefficient source of energy production; 2 ATP for every glucose; produces pyruvic acid
6 O2 GLUCOSE METABOLISM 6 CO2 6 H2O 36 ATP HEAT (417 kcal) Oxidative phosphorylation: Each pyruvic acid is converted into 34 ATP
Occurs without oxygen oxidative phosphorylation cant occur without oxygen glycolysis can occur without oxygen cellular death leads to tissue and organ death can occur even after return of perfusion organ dysfunction or death
Inadequate Cellular Oxygen Delivery Anaerobic Metabolism Inadequate Energy Production Metabolic Failure Lactic Acid Production Metabolic Acidosis CELL DEATH Ultimate Effects of Anaerobic Metabolism
Markers Of Hypo perfusion Serum Lactate Metabolic acidosis Hypotension
Adequate Volume Normal Cardiac Function Normal Vessels Failure of one or more of these causes shock
Hypovolemic Shock - Blood volume problem Cardiogenic Shock - Blood pump problem Obstructive Shock - Filling Problem Distributive Shock - Blood vessels problem
Loss of Volume Blood loss Trauma Non-traumatic Vaginal GI GU Fluid loss - Dehydration - Burns - Diarrhea - Vomiting - Diuresis - Sweating Third space losses Pancreatitis Peritonitis Bowel obstruction
Sign and Symptoms Brain Decreased mental status Kidney Oliguria Liver Increased liver enzymes Lung Hypoxemia Pheripheral Circulation Hypotension Cold Clammy skin
Recognize & Treat during compensatory phase Restlessness, anxiety, combativeness = Earliest signs of shock Best indicator of resuscitation effectiveness = Level of Consciousness
Tissue ischemic sensitivity Heart, brain, lung: 4 to 6 minutes GI tract, liver, kidney: 45 to 60 minutes Muscle, skin: 2 to 3 hours Resuscitate Critical Tissues First
Goal: Restore circulating volume, tissue perfusion & correct cause A B C Two large bore IV lines/central line Fluids / Blood & Products /vasopressors Target arterial BP SBP 90 mmHg - MAP 65 mmHg. Catheterize the bladder IV Cannulation
Consequences of volume loss 15%[750ml]- compensatory mechanism maintains cardiac output 15-30% [750-1500ml]-decreased BP & urine output 30-40% [1500-2000ml] -profound shock along with severe acidosis 40-50% - refractory stage
Cardiogenic Shock = Pump Failure Myopathic -M I -CHF -Cardiomyopathy Arrhythmic -Tachy or bradyarrhythmias Mechanical -Valvular Failure
History Chest pain, Palpitations, SOB RHD, IHD Physical exam Signs of ventricular failure Heart : Murmurs,S3,S4
Treat rate, then rhythm, then BP Correct bradycardia or tachycardia Correct irregular rhythms Treat BP Cardiac contractility (inotropes) Dobutamine, Dopamine
Inadequate perfusion of tissues due to mal- distribution of blood flow (blood vessels problem) Cardiac pump & blood volume are normal but blood is not reaching the tissues.
Septic Shock Anaphylactic Shock Neurogenic/Vasogenic (spinal cord)
Septic shock is the most common cause of distributive shock and is caused by an overwhelming systemic infection that cannot be cleared by the immune system, resulting in vasodilation and hypotension
A B C Assist ventilation & Augment Oxygenation Restore Tissue perfusion- IV Fluids, Vasopressors Identification & Eradication of septic foci Specific therapies (antibiotics)
Anaphylactic shock is caused by a severe reaction to an allergen, leading to the release of histamine that causes widespread vasodilation and hypotension. In Anaphylaxis blood pressure drops suddenly and the airways narrow, blocking breathing. Signs and symptoms include a rapid, weak pulse; a skin rash; and nausea and vomiting. Common triggers include certain foods, some medications, insect venom and latex.
Epinephrine (adrenaline) to reduce the body's allergic response. Oxygen, to help breathe. Intravenous (IV) antihistamines and cortisone to reduce inflammation of the air passages and improve breathing. A beta-agonist (such as albuterol) to relieve breathing symptoms. Isotonic Fluids
Neurogenic shock arises due to damage to the central nervous system, which impairs cardiac function by reducing heart rate and loosening the blood vessel tone, resulting in severe hypotension
Patient supine; lower extremities elevated Avoid Trendelenburg Infuse isotonic crystalloid Maintain body temperature
Obstructive shock is a condition that prevents blood and oxygen from getting to organs Something is obstructing or getting in the way of blood going into and out of the heart or great vessels Lead to drop in blood pressure and the amount of blood the heart is able to pump
Impaired cardiac filling Cardiac tamponade Constrictive pericarditis Tension pneumothorax Increased ventricular afterload Pulmonary embolism
Control airway Intubation Treat the underlying cause Tension Pneumothorax: Chest tube Pericardial Tamponade: Pericardiocentesis Pulmonary Embolism: Anticoagulation Isotonic fluids
Falling BP = late sign of shock. BP is not same thing as perfusion. Pallor, tachycardia, slow capillary refill = hypo perfusion, until proven otherwise.
Avoid vasopressors until hypovolemia ruled out, or corrected Squeezing partially empty tank can cause ischemia, necrosis of kidney and bowel
power point presentation on shock management.pptx

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power point presentation on shock management.pptx

  • 2. Definition & mechanism of shock. Consequences of Shock. How to diagnose shock? Classification of Shock. Causes of various types of shock Basic principles in management of shock.
  • 3. Shock is reduction of effective tissue perfusion leading to cellular and circulatory dysfunction It is a medical emergency, if unrecognized or inadequately treated will result in high mortality
  • 5. The aim of perfusion is to achieve adequate Cellular Oxygenation This requires Red Cell Red Cell Oxygenation Delivery To Tissues
  • 6. Red Cell Oxygenation 1. Oxygen delivery to alveoli Adequate FiO2 Patent airways Adequate ventilation
  • 7. 2. Oxygen exchange with blood Adequate oxygen diffusion into blood Adequate RBC capacity to bind O2 pH Temperature
  • 8. Red Cell Delivery To Tissues 1. Adequate perfusion Blood volume Cardiac output Heart rate Stroke volume Conductance Arterial resistance Venous capacitance
  • 9. 2. Adequate Hgb Adequate Hgb levels Adequate RBC capacity to bind O2 pH Temperature
  • 10. Inadequate tissue perfusion: Poor cellular Shift from aerobic Oxygenation to anaerobic metabolism
  • 11. GLUCOSE METABOLISM 2 LACTIC ACID 2 ATP HEAT (32 kcal) Glycolysis: Inefficient source of energy production; 2 ATP for every glucose; produces pyruvic acid
  • 12. 6 O2 GLUCOSE METABOLISM 6 CO2 6 H2O 36 ATP HEAT (417 kcal) Oxidative phosphorylation: Each pyruvic acid is converted into 34 ATP
  • 13. Occurs without oxygen oxidative phosphorylation cant occur without oxygen glycolysis can occur without oxygen cellular death leads to tissue and organ death can occur even after return of perfusion organ dysfunction or death
  • 15. Markers Of Hypo perfusion Serum Lactate Metabolic acidosis Hypotension
  • 16. Adequate Volume Normal Cardiac Function Normal Vessels Failure of one or more of these causes shock
  • 17. Hypovolemic Shock - Blood volume problem Cardiogenic Shock - Blood pump problem Obstructive Shock - Filling Problem Distributive Shock - Blood vessels problem
  • 18. Loss of Volume Blood loss Trauma Non-traumatic Vaginal GI GU Fluid loss - Dehydration - Burns - Diarrhea - Vomiting - Diuresis - Sweating Third space losses Pancreatitis Peritonitis Bowel obstruction
  • 20. Recognize & Treat during compensatory phase Restlessness, anxiety, combativeness = Earliest signs of shock Best indicator of resuscitation effectiveness = Level of Consciousness
  • 21. Tissue ischemic sensitivity Heart, brain, lung: 4 to 6 minutes GI tract, liver, kidney: 45 to 60 minutes Muscle, skin: 2 to 3 hours Resuscitate Critical Tissues First
  • 22. Goal: Restore circulating volume, tissue perfusion & correct cause A B C Two large bore IV lines/central line Fluids / Blood & Products /vasopressors Target arterial BP SBP 90 mmHg - MAP 65 mmHg. Catheterize the bladder IV Cannulation
  • 23. Consequences of volume loss 15%[750ml]- compensatory mechanism maintains cardiac output 15-30% [750-1500ml]-decreased BP & urine output 30-40% [1500-2000ml] -profound shock along with severe acidosis 40-50% - refractory stage
  • 24. Cardiogenic Shock = Pump Failure Myopathic -M I -CHF -Cardiomyopathy Arrhythmic -Tachy or bradyarrhythmias Mechanical -Valvular Failure
  • 25. History Chest pain, Palpitations, SOB RHD, IHD Physical exam Signs of ventricular failure Heart : Murmurs,S3,S4
  • 26. Treat rate, then rhythm, then BP Correct bradycardia or tachycardia Correct irregular rhythms Treat BP Cardiac contractility (inotropes) Dobutamine, Dopamine
  • 27. Inadequate perfusion of tissues due to mal- distribution of blood flow (blood vessels problem) Cardiac pump & blood volume are normal but blood is not reaching the tissues.
  • 28. Septic Shock Anaphylactic Shock Neurogenic/Vasogenic (spinal cord)
  • 29. Septic shock is the most common cause of distributive shock and is caused by an overwhelming systemic infection that cannot be cleared by the immune system, resulting in vasodilation and hypotension
  • 30. A B C Assist ventilation & Augment Oxygenation Restore Tissue perfusion- IV Fluids, Vasopressors Identification & Eradication of septic foci Specific therapies (antibiotics)
  • 31. Anaphylactic shock is caused by a severe reaction to an allergen, leading to the release of histamine that causes widespread vasodilation and hypotension. In Anaphylaxis blood pressure drops suddenly and the airways narrow, blocking breathing. Signs and symptoms include a rapid, weak pulse; a skin rash; and nausea and vomiting. Common triggers include certain foods, some medications, insect venom and latex.
  • 32. Epinephrine (adrenaline) to reduce the body's allergic response. Oxygen, to help breathe. Intravenous (IV) antihistamines and cortisone to reduce inflammation of the air passages and improve breathing. A beta-agonist (such as albuterol) to relieve breathing symptoms. Isotonic Fluids
  • 33. Neurogenic shock arises due to damage to the central nervous system, which impairs cardiac function by reducing heart rate and loosening the blood vessel tone, resulting in severe hypotension
  • 34. Patient supine; lower extremities elevated Avoid Trendelenburg Infuse isotonic crystalloid Maintain body temperature
  • 35. Obstructive shock is a condition that prevents blood and oxygen from getting to organs Something is obstructing or getting in the way of blood going into and out of the heart or great vessels Lead to drop in blood pressure and the amount of blood the heart is able to pump
  • 36. Impaired cardiac filling Cardiac tamponade Constrictive pericarditis Tension pneumothorax Increased ventricular afterload Pulmonary embolism
  • 37. Control airway Intubation Treat the underlying cause Tension Pneumothorax: Chest tube Pericardial Tamponade: Pericardiocentesis Pulmonary Embolism: Anticoagulation Isotonic fluids
  • 38. Falling BP = late sign of shock. BP is not same thing as perfusion. Pallor, tachycardia, slow capillary refill = hypo perfusion, until proven otherwise.
  • 39. Avoid vasopressors until hypovolemia ruled out, or corrected Squeezing partially empty tank can cause ischemia, necrosis of kidney and bowel