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Shock: Clinical features and pathophysiology Mahesh Nirmalan Critical Care Unit, Manchester Royal Infirmary

Shock: Clinical features and pathophysiology Mahesh Nirmalan Critical Care Unit, Manchester Royal Infirmary

Objectives

Life-threatening condition Immediate or delayed mortality Multiple aetiology Recognition and Assessment Physiological consequences of shock clinical features Document and report on progression

Definition of Shock

Inadequate tissue perfusion Decreased oxygen supply Anaerobic metabolism Accumulation metabolic waste

Causes of Shock

Severe or sudden blood loss Large drop in body fluids Myocardial infarction Major infections High spinal injuries Anaphylaxis Extreme heat or cold

Types of Shock

Hypovolemic Shock: haemorrhagic or non haemorrhagic Other causes of shock Cardiogenic Shock Septic Shock Neurogenic Shock Anaphylactic Shock

Harvest of Death: T H O’Sullivan

Hypovolaemic Shock

Haemorrhage: Overt or occult Reduction in circulating volume Reduction in venous return and CO O2 supply-demand imbalance Lactic acidosis Reduction in venous oxygen saturation Non haemorrhagic hypovolaemia Severe burns, vomiting and diarrhoea

CO, MAP and SvO2

Effect of EDV and contractility on SV

Changes in CO and MAP in haemorrhage

Clinical Signs of Acute Hemorrhagic Shock

% Blood loss Clinical Signs < 15 Slightly increased heart rate, local swelling, bleeding 15-30 Increased heart rate, increased diastolic blood pressure, prolonged capillary refill 30-50 Above findings plus: hypotension, confusion, acidosis, decreased urine output > 50 Refractory hypotension, refractory acidosis, death

Signs of Shock

Cold, clammy and pale skin Rapid, weak, thready pulse Shallow, rapid breathing Oliguria Reduction in MAP Cyanosis Loss of consciousness

Non-Haemorrhagic Shock

Cardiogenic Shock Septic Shock Neurogenic Shock Anaphylactic Shock

Cardiogenic Shock

Primary myocardial failure Arrhythmia Tamponade Contusion Pump failure Reduction in cardiac output: Decreased blood supply Decreased oxygen delivery

Cardiogenic Shock

Assess for: Signs of heart failure Signs of tamponade Cardiac dysrrhythmia Myocardial infarction Tachycardia Muffled heart sounds or third heart sound Engorged neck veins with hypotension Dyspnoea Oedema in feet and ankles

Septic Shock

Bacterial, viral, fungal infection Gram negative and gram positive bacteria High output failure: “warm shock” Fever, tachycardia, tachypnoea, leucocytosis Inadequate oxygen extraction High SvO2, Metabolic acidosis “Cold shock” Atypical presentation in immuno-compromised patients Diabetes, Cirrhosis, immunosuppression

Septic Shock in trauma patients

Develops 2 - 5 days after injury occurs Carries a poor prognosis Assess for: Penetrating abdominal injuries Signs of infection Warm pink skin and dry elevated body temperature Tachycardia Wide pulse pressures

Neurogenic Shock

Caused by: Spinal cord injury Certain drugs Brain stem, spinal or torso trauma Venous pooling and arteriolar dilatation Signs and Symptoms: Hypotension without tachycardia Warm pink skin Low blood pressure & minimal response to fluids

Anaphylactic shock

Anaphylactic Shock

Rapid onset Primary systems: Cardiovascular, Respiratory Skin, Gastrointestinal, coagulation Face, pharynx and laryngeal oedema Adrenaline is life saving

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Shock_lecture_7th_Apri...
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Melissa Hite
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KPMG
Description: 
Shock: Clinical features and pathophysiology Mahesh Nirmalan Critical Care Unit, Manchester Royal Infirmary
Tags: 
shock | blood | sign | pressur | haemorrhag | anaphylact | reduct | tachycardia
Created: 
2/2/2001 10:38:56 PM
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