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    RTC Shock

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    Marcel
    This document defines shock and its various types, including hypovolemic, cardiogenic, distributive, obstructive, and endocrine shock. It outlines the cellular mechanisms of shock and describes the clinical presentation and stages of shock. Diagnostic workups and treatments for different shock types are discussed. The most important first step in treating shock is recognizing that a patient is in shock.

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    RTC Shock

    Uploaded by

    Marcel
    172 views16 pages
    This document defines shock and its various types, including hypovolemic, cardiogenic, distributive, obstructive, and endocrine shock. It outlines the cellular mechanisms of shock and describes the clinical presentation and stages of shock. Diagnostic workups and treatments for different shock types are discussed. The most important first step in treating shock is recognizing that a patient is in shock.

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    This document defines shock and its various types, including hypovolemic, cardiogenic, distributive, obstructive, and endocrine shock. It outlines the cellular mechanisms of shock and describes the clinical presentation and stages of shock. Diagnostic workups and treatments for different shock types are discussed. The most important first step in treating shock is recognizing that a patient is in shock.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    172 views16 pages

    RTC Shock

    Uploaded by

    Marcel
    This document defines shock and its various types, including hypovolemic, cardiogenic, distributive, obstructive, and endocrine shock. It outlines the cellular mechanisms of shock and describes the clinical presentation and stages of shock. Diagnostic workups and treatments for different shock types are discussed. The most important first step in treating shock is recognizing that a patient is in shock.

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    Shock

    Kenneth Stahl MD FACS

    OBJECTIVES
    1. Define shock and apply to clinical situations
    2. Recognize clinical presentations of shock
    3. Learn the cellular mechanisms and sub-cellular
    biochemistry of shock
    4. Learn the degrees and grades of shock
    5. Understand diagnostic tests used in patients with
    shock
    6. Learn treatments for various types of shock
    5? of Types of Shock
    1. Hypovolemic shock
    2. Cardiogenic shock
    Septic/neurogenic
    3. Distributive shock → ?
    shock
    4. Obstructive shock
    5. Endocrine shock
    3? Stages of Shock
    1. Pre-shock (warm shock or compensated shock): rapid
    compensation for diminished tissue perfusion by
    homeostatic mechanisms

    2. Shock: compensatory mechanisms become overwhelmed


    and signs and symptoms of organ dysfunction
    appear - tachycardia, dyspnea, restlessness,
    diaphoresis, metabolic acidosis, oliguria, cool
    clammy skin

    3. End-organ dysfunction : irreversible organ damage, no


    urine output (anuria and acute renal failure),
    acidemia ,decreases the cardiac output ,coma and
    patient death
    Shock - Clinical Presentation
    1. Anxiety, restlessness, altered mental state (↓cerebral
    perfusion and subsequent hypoxia)
    2. Hypotension (↓cardiac output, ↓stroke volume)
    3. Pulse (rapid, weak, thready)
    4. Cool, clammy, mottled skin (vasoconstriction,
    hypoperfusion)
    5. Oliguria (↓renal perfusion)
    6. Hyperventilation (sympathetic nervous system
    stimulation and acidosis)
    7. Fatigue (late)
    8. Absent pulse in tachyarrhythmia
    Shock
    Cellular Pathophysiology
    Inadequate tissue perfusion
    Cellular hypoxia
    Energy deficit Anaerobic Metabolism
    Vasoconstriction Lactic acid accumulation (↓pH)
    ↓ Pre-capillary Metabolic acidosis
    sphincters
    Cell membrane dysfunction
    Peripheral blood (↓NaK cell membrane pump) K+ Efflux
    pooling
    Intracellular lysosome release Na+ H20 Influx
    Buildup of intracellular toxins Cellular swelling
    ↓Tissue
    Capillary endothelium damage
    perfusion
    ↓Urine Cell dysfunction and apoptosis
    output
    Patient death
    Shock Diagnostic Work Up
    1. There is NO single diagnostic test for shock
    2. Hypotensive trauma patient is in shock
    3. Physical Examination
    4. Patient history (trauma/injury, sepsis, MI)
    5. FST (sometimes)
    6. Swan-Ganz catheter (late, not very useful)
    7. Pro-BNP (Cardiogenic shock)
    8. EKG (arrhythmia)
    Hemorrhagic Shock
    Mechanisms
    Blood Loss
    4 Classes of Shock
    Class I Class II Class III Class IV
    Volume Loss 750 – 1500 -
    <750 cc 1500 cc 2000 cc >2000cc

    % Blood
    <15% 15-25% 25-40% >40%
    volume
    ∆ Blood
     to none ↓ to none ↓↓ ↓↓ to
    Pressure absent
    ∆ Heart Rate 100 - 120 -
    <100 >140
    beats/minute 120 140

    ∆ Pulse none to ↑ ↓ ↓↓ ↓↓ to
    Pressure DBP absent
    ∆ CNS none to slightly mildly anxious to confused
    anxious anxious confused to lethargic

    ∆ Respiratory normal 20-30 30-40 >40


    rate
    Treatment of Hemorrhagic Shock

    1. RECOGNIZE patient is in shock


    2. ATLS (ABCDE’s)
    3. Volume, volume, volume
    4. Surgical – stop bleeding, correct injury
    5. Re-establish normal hemodynamics
    6. Re-establish urine flow
    Obstructive Shock

    1. Cardiac Tamponade
    2. Tension Pneumothorax
    3. Mediastinal Crushing Injury
    (caval obstruction)
    4. Aortic dissection (obstruction)
    5. Mediastinal Torsion
    6. Pulmonary Embolism
    Diagnosis of Obstructive Shock
    1. RECOGNIZE patient is in shock
    2. Mechanism of Injury
    3. Physical examination
    4. Chest x-ray, FST, 2-D Echo
    Distributive Shock
    Neurogenic/Septic Shock
    1. Low systemic vascular resistance (SVR)
    2. Spinal chord trauma (neurogenic shock)
    3. Gram negative sepsis
    Treatment Distributive Shock
    Neurogenic/Septic Shock
    1. Control systemic vascular resistance (SVR)
    2. Hemodynamic support
    3. Source control (drain abscess, ∆ CVP lines)
    4. Stabilize spinal chord (neurogenic shock)
    5. Treat gram negative sepsis (broad
    spectrum antibiotics)
    Caridogenic Shock

    1. Valve dysfunction (acute, chronic) AS,AI,MR


    2. Prosthetic valve dysfunction (thrombus,
    dehiscence)
    3. LV failure (Frank-Starling curves)
    4. Arrhythmia (Ventricular, Atrial)
    5. Aortic dissection (acute AI, tamponade, MI)
    Endocrine Shock
    1. Acute adrenal deficiency
    2. Hypothyroidism
    3. Hyperthyroidism (thyrotoxicosis)
    Summary
    1. Shock is an circulatory system abnormality
    that results in inadequate tissue perfusion
    2. Hypovolemia is the cause of shock in the
    majority of trauma patients
    3. Hypovolemic shock has 4 stages from mild to
    fatal
    4. There is NO DIAGNOSTIC test for shock
    5. The most important and first treatment for
    shock is RECOGNIZING patient is in shock

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