Post Contents List
- 1 Shock
- 2 Aims of Treatment in Shock
- 3 History in Shock
- 4 Risk Factorsfor Shock
- 5 Pathogenesis of Shock
- 6 Systemic vascular response increases so that there is :
- 7 Vasodilator substances in shock:
- 8 Cardiovascular response
- 9 Pulmonary response
- 10 Renal response
- 11 Metabolic effects
- 12 Monitoring the Patient with shock
- 13 TYPES OF SHOCK
- 14 HYPOVOLEMIC SHOCK
- 15 Presentation
- 16 Management
- 17 TRAUMATIC SHOCK
- 18 Management
- 19 INTRINSIC CARDIOGENIC SHOCK
- 20 Treatment –
- 21 COMPRESSIVE CARDIOGENIC SHOCK
- 22 NEUROGENIC SHOCK
- 23 HYPOADRENAL SHOCK
- 24 OTHER THERAPIES IN SHOCK
- 25 SEPTIC SHOCK
Shock is a clinicalPolycythemia Vera Myelofibrosis Thrombocytosis Cause Diagnosis Treatment. Read more ... » syndromeMetabolic,Insulin Resistance Syndrome X Causes Symptoms. Read more ... » due to inadequate tissue perfusion.
A clinical syndrome marked by inadequate perfusion and oxygenation of cells, tissues, and organs, usually as a result of marginal or markedly lowered blood pressureChronic Long-term Complications Of Diabetes Mellitus. Read more ... ».
Shock is the physiologic state characterized by significant reduction of systemic tissue perfusion, resulting in decreased tissue oxygen delivery.
- This leads to Cellular dysfunction leading to production and release of inflammatory mediators which act on the microvasculature.
- Cellular injury —–> Multiple Organ Failure ——> Death
- The cellular injury is reversible or irreversible.
Aims of Treatment in Shock
- Restore perfusion by expansion of blood volume
- Check the cause like:
- - Haemorrhage
- Impairment of cardiacFirst degree AV block,Second degree AV block (Mobitz type I,Mobitz type Il),Third degree AV block. Read more ... » functions
History in Shock
- Hypovolemic shock: Burns, trauma, bleeding wound(s), hematemesis, vomitingNausea and Vomiting. Read more ... », abdominal pain, melena, diarrhea, vaginal bleedingAPH (Antepartum Haemorrhage) and Placenta previa (PP) Diagnosis Symptoms. Read more ... »
- Cardiogenic shock: DizzinessDizziness cause diagnosis treatment. Read more ... », chest painApproach to Chest Pain Differential diagnosis of chest pain. Read more ... », dyspnea, palpitations
- Septic shockSepsis (Septic Shock) Definition Diagnosis and Pathophysiology. Read more ... »: FeverThyrotoxic crisis or Thyroid storm. Read more ... », chills, rigors, malaise, myalgias, cough, shortness of breath, productive sputum, dysuria, suprapubic pain, flank painChronic pancreatitis Causes Symptoms Diagnosis and Treatment. Read more ... »
- Neurogenic: Spinal trauma
- Hypovolemic shock: Hemorrhage, dehydration, burns, anaphylactic (decreased effective circulating volume)
- Cardiogenic shock: HeartFirst degree AV block,Second degree AV block (Mobitz type I,Mobitz type Il),Third degree AV block. Read more ... » diseasePolycythemia Vera Myelofibrosis Thrombocytosis Cause Diagnosis Treatment. Read more ... » such as MI and congestive heart failureHeart Failure Causes Symptoms NYHA classification with Heart Failure Treatment. Read more ... » (CHF)
- Septic shock: Elderly, immunosuppression, critical illness, malnutrition, cancerUses of Ayurveda for Improvement in Cancer Patients Treatment. Read more ... »
- Neurogenic: Spinal cord injury
Pathogenesis of Shock
- Cardiac output falls below 60%.
- There is hypotensionHyperglycemic Hyperosmolar State (HHS) Acute Complication Of DM. Read more ... » i.e. mean <60 mmHg.
Systemic vascular response increases so that there is :
- Increased perfusion of brain and heart.
- · Decreased perfusion of skin, muscles, GITToxoplasma Infection Transmission Clinical Manifestations Diagnosis Treatment. Read more ... ». Cerebral and coronary perfusion is maintained spite fall of blood pressure.
- Arterioles have vascular smooth muscle.
- Vascular smooth muscles have Alfa and Beta adrenergic receptors.
- Alfa-1 receptors cause Vasoconstriction.
- Beta-2 receptors cause Vasodilatation.
- Norepinephrine released from efferent sympathetic fibers act on ~ receptors.
- Epinephrine and norepinephrine are released by adrenalLABORATORY TESTS FOR ADRENAL FUNCTIONS. Read more ... » medulla.
- Other vasoconstrictors are :
- angiotensin II,
- thromboxane A2.
Vasodilator substances in shock:
- PG 12
- Nitric oxide
Derangement of cellular metabolism leads to cell death resulting in organ failure.‘ There is :
- · Hypovolemia
- · Hypotension
- · Hypoxia.
- Autonomic response —> decreased vagal response, increased heart rate, increased cardiac output, increased glycogenolysis and gluconeogenesis.
- Severe pain, severe stress leads to increased ACTH and increased blood volume.
- Release of renin —> Angiotensin I —> angiotensin Il —> Vasoconstriction —> aldosteroneLABORATORY TESTS FOR ADRENAL FUNCTIONS. Read more ... » release by adrenal cortex —> Vasopressin by posterior pituitaryGrowth and Development Disorders GHD Diagnosis Treatment. Read more ... ».
- Aldosterone and Vasopressin enhance water reabsorption and cause vasoconstriction.
- Decreased cardiac output
- Decreased strokeHyperglycemic Hyperosmolar State (HHS) Acute Complication Of DM. Read more ... » volume
- Increased heart rate
- Increased systemic vascular resistance
- Vasoconstriction and peripheral vasoconstriction are compensatory responses.
- Tachypnea —> Hypoxia —> Respiratory alkalosisAcidosis & Alkalosis physiology with signs and symptoms. Read more ... » —> Atelectasis —> AcutePolycythemia Vera Myelofibrosis Thrombocytosis Cause Diagnosis Treatment. Read more ... » Lung Injury —> Acute respiratory distress syndrome
- Shock —> acute tubular necrosis —> decreased GFR —> increased Angiotensin —> increased aldosterone and vasopressin —> decreased urine formation Low dose dopamine may be useful.
- Disruption of Lipid,
- Carbohydrate and protein metabolism.
Monitoring the Patient with shock
- · ICU admission
- · Monitor arterial pressure (intraarterial)
- · Pulse
- · Respiratory rate
- · Urine flow (Foley’s catheter)
- · Mental status
- · Pulmonary arterial catheter (for Right atrial, Pulmonary arterial, and Pulmonary wedge pressure)
- · Cardiac output
- · 02 consumption, 02 delivery
- · Systemic vascular resistance to be maintained.
TYPES OF SHOCK
- · Haemorrhage
- · Loss from GIT, urinary, insensible loss (extravascular fluid sequestration)
- · TachycardiaHyperglycemic Hyperosmolar State (HHS) Acute Complication Of DM. Read more ... »
- Postural hypotension, Severe hypotension
- Mental obtundation
- Differentiation from cardiogenic shock by absence of S3, rales, jugular venous distension.~
- Give volume:
- · Isotonic saline (2-3 litres in 112 hour)
- · Blood transfusion (0 +ve packed RBCs).
- · Dopamine
- · Vasopressin
- · Dobutamine (No norepinephrine)
- · Oxygen
- · Endotracheal intubation.
- · Haemorrhage
- · Hypovolemia
- · Pain
- · Tissue ischemia
- Pericardial tamponade
- Tension PneumothoraxPneumothorax Symptoms Causes Diagnosis Treatment with emergency. Read more ... »
- Myocardial injury.
- · Airway
- · Breathing
- · Circulation
- · Control haemorrhage
- · Antioxidants.
INTRINSIC CARDIOGENIC SHOCK
- It is complicationHyperglycemic Hyperosmolar State (HHS) Acute Complication Of DM. Read more ... » of Myocardial Infarction.
- · Decreased cardiac output
- · Pulmonary congestion
- · Increased systemic vascular resistance / Left ventricular failure / Right ventricular failure / Pulmonary arterial hypertensionThyroid Disorders Examination and Laboratory tests. Read more ... » ~ alveolar edema
- · There is no hypovolemia.
- Management of AMIAcute Myocardial Infarction Management REGIME FOR MANAGEMENT OF AMI. Read more ... » to be done Dopamine
- Intra Aortic Balloon Pump
- Ventricular Assist Device
- Heart transplantation.
COMPRESSIVE CARDIOGENIC SHOCK
- · Tamponade
- · Increased intrathoracic pressure
- · Tension pneumothorax
- · Intermittent positive pressure ventilation (excessive)
- ·Acute right heart failure in pulmonary embolism. There is pulsus paradoxus.
- · High cervical cord injury
- · Spinal anaesthesia (Cephalad migration)
- · Head injury.
- · Give fluids
- · Norepinephrine.
- Adrenal insufficiency in stress, surgery, illness, trauma, sepsisSepsis (Septic Shock) Definition Diagnosis and Pathophysiology. Read more ... », (due to previous high dose of exogenous corticosteroids) in patients of :
- · Tuberculosis
- · Metastatic disease
- · Bilateral haemorrhage
- · AmyloidosisAmyloidosis Symptoms Diagnosis Prognosis and Treatment. Read more ... »
- Dexamethasone – 4 mg· IV
- Hydrocortisone – 100 mg IV 6 – 8 hourly.
OTHER THERAPIES IN SHOCK
- · Elevation of foot
- · Pneumatic antishock garment
- · Rewarming.
Systemic responses to infection:
- · Fever
- · Hypothermia
- · Tachypnea
- · Tachycardia.