Shock and Resuscitation

Posted by e-Medical PPT Monday, March 19, 2012
Definition of Shock
Condition of inadequate delivery of oxygen and nutrients necessary for normal tissue and cellular function

Types of Shock
Hypovolemic
Inflammatory
Compressive
Neurogenic
Cardiogenic

Compressive Shock
External forces compress the chambers of the heart or great veins (VC) resulting in decreased cardiac filling / cardiac output.
Mechanism of Tension Pneumothorax?

Other Method of Compressive Shock?
Pericardial Tamponade
Compression by fluid in pericardial sac obstructs contraction by heart
Sx:  Beck’s Triad

Hypovolemic shock
Acute blood loss in trauma patient results in loss of circulatory volume
 SNS stimulation, Release of epinephrine and norepinephrine
 Vasopressin release
 Activation of Renin angiotensin cascade
 Vasosconstriction to maintain cerebral and coronary blood flow
Shock in a trauma patient should be presumed to be due to hemorrhage until proven otherwise

Sources of Bleeding
External
Thoracic - CXR
Intraperitoneal - DPL,FAST,CT
Retroperitoneal-Pelvic Fractures,CT, angiography

Irreversible shock
Ongoing fluid / blood requirement despite control of hemorrhage
Persistent hypotension despite restoration of intravascular volume
Futile cycle of uncorrectable hypothermia, hypoperfusion, acidosis, coagulopathy
Inevitably terminal

Septic Shock
By product of body’s response to infection. 
In attempt to eradicate pathogens, reticuloendothelial system releases cytokines which modulate inflammatory cells fxn. 
Increase in microvascular flow enhances delivery of killing forces to areas of infection. 
Sepsis occurs when this occurs systemically – hemodynamic collapse.

Signs:    Early– warm w/ vasodilation, often adequate urine  
                          output, febrile, tachypneic.
              Late--  vasoconstriction, hypotension, oliguria,
                          altered mental status.

SVR is low – inflammatory mediators cause increased permeability in tissues

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