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What is shock? Acute failure of circulation resulting in impaired or absent perfusion to
tissues and subsequent insufficient oxygen provision to cells.
Causes of Hypovolaemic shock Obvious blood loss (external)
Internal blood loss, any major source of internal bleeding
MASSIVE vomiting and/or diarrhea
Pathophysiology BASICALLY:
Lost circulating volume, less blood goes into heart, less blood therefore gets pumped out of the heart, therefore BP drops.
END RESULT? Oxygen delivery impaired, cells are gradually doomed
Signs and Symptoms Cold pale clammy skin. Poor cap. Refill
Tachycardia
BP – early is increased, later on drops
Tachypnoea
Oligo/Anuria
Confusion, restlessness, anxiety, dizziness
Switch to Anaerobic metabolism, results in lactic acid production and acidosis
Cardiogenic Usually due to MI, heart can no longer pump blood
Backlog of blood builds up in lungs: RV failure - JVP Dyspnoea Crackles/wheeze Pulmonary oedema
Diagnosis and Management History, ECG, Trop T, angiography
Morphine, Oxygen, Nitrates, Aspirin
Thrombolysis
Fluids or diuretics?
Mechanical Shock Tension pneumothorax & Cardiac tamponade: prevent filling of heart
PE: Overloading of RV and hypovolaemia of LV
All present with features of shock, fix underlying cause
Septic Shock Infection of the blood results in systemic inflammatory response and mass
vasodilation – fluids leaks out.
Tachycardia
Tachypnoea
Hypotension
Fever OR Hypothermia
WCC >12 or <4
Septic Shock Early on – warm (vasodilated peripheries), as condition progresses becomes
cold.
Rigors are common.
SEPSIS SIX FBC
High flow oxygen
Fluid resus
Urine output
Blood culture & serum lactate
High dose empirical antibiotics
Administer if sepsis is SUSPECTED. Treat as septic until proven otherwise.
Multi organ failure and mortality rates are very high
Anaphylactic Shock IgE mediated – type I hypersensitivity
Allergen stimulates IgE to bind mast cells which then degranulate and release histamine.
Vasodilation and increased capillary permeability.