SHOCKMAHMUD

OBJECTIVESIdentify the 4 main catogories of shock.Discuss goals of resuscitation in shock.Summarize the general principles of shock management.Describe the physiologic effects of vasopressor and inotropic agents.Discuss the differential diagnosis of oligouria.

Case StudyA 25 years old women with no prioe history presents to the emergency departement complaining a cough productive of tenacious greenish yellow mucous. Vital signs are temperature 38,80C, heart rate 129/mnt, respiratory rate 27/min, and blood pressure 112/68 mmHg.What information is needed to determine if this patient has shock?What initial interventions are needed to stabilize the patient?

I. INTRODUCTION

II. Clinical alterations in shock

III. Classification of shockHypovolemic CardiogenicHemorragic Myopatic (ischemic)Nonhemorragic Mechanical (valvular)Distributive ArrhytmicSepticAdrenal crisis ObstructiveNeurogenic (spinal shock) Massive pulmonary embolism Tension pneumothorax Cardiac tamponade Constriction pericarditis FCCS 2007

Hemodynamic Profiles of shockType of shockHeart RateCardiac OutputVentricular FillingPressuresSystemic VascularResistencePulse PressureSVO2/ ScVO2

CardiogenicHypovolemicDtistributionObstructive

Causes of Inadequate PerfusionInadequate pumpInadequate preloadPoor contractilityExcessive afterloadInadequate heart rateInadequate fluid volumeHypovolemiaInadequate containerExcessive dilationInadequate systematic vascular resistance

Responses to ShockNormal compensation includes:Progressive vasoconstrictionIncreased blood flow to major organsIncreased cardiac outputIncreased respiratory rate and volumeDecreased urine output

Cellular Response to ShockTissueperfusion

Cardiogenic Shock CO

Neurogenic Shock Sympathetic ToneOr Parasympathetic Tone

Anaerobic? So What?InadequateCellularOxygenation