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LAB. FINDINGS :
e.g. :
- METABOLIC ASIDOSIS FOR ALL KINDS OF
SHOCK
- HEMOCONCENTRATION FOR HYPOVOLEMIC
SHOCK
- BACTERIEMIA FOR SEPTIC SHOCK
- TENSION (PNEUMOTHORAX WITH LUNG
COLLAPS
AND MEDIASTINUM SHIFT ON CHEST X-RAY)
FOR
OBSTRUCTIVE SHOCK
- CARDIOMEGALI OR ABNORMALITY OF
CARDIAC
APPEARANCE IN CHEST X-RAY AND ECG FOR
CARDIAC SHOCK
II. BASIC PRINCIPLES
OF SHOCK MANAGEMENT
AIRWAY FREE
ADEQUATE BREATHING
( VENTILATE THE ALVEOLI, OPTIMIZED BLOOD
OXYGENATION, INCREASE O2 DELIVERY & TISSUE
OXYGENATION )
ADEQUATE CIRCULATION
(INCREASE CARDIAC OUTPUT & BLOOD PRESSURE
WITH FLUID, POSITIVE INOTROPES AND
VASOPRESSORS DEPEND ON THE CAUSA &
PATHOPHYSIOLOGY)
SEARCH CAUSA AND TREAT PROMPLY
GUIDE OF TREATMENT WITH CLOSED MONITORING
GENERAL EARLY TARGET
IN SHOCK RESUSCITATION
COMPOS MENTIS
A & B NORMAL
C : BP SYSTOLE > 90 mmHg,
HR < 100 x/mnt
Cap. Refill < 2 sec.
warm extremities
FLUID : URINE PROD. > 0,5
cc/kg/hr
Face mask-valve-bag
III. MAJOR CATAGORIES OF
SHOCK
1. HYPOVOLEMIC SHOCK
2. CARDIOGENIC SHOCK
3. DISTRIBUTIVE SHOCK
4. OBSTRUCTIVE SHOCK
HYPOVOLEMIC SHOCK
DEPLETION OF INTRAVASCULAR
VOLUME
CAUSA : LAKE OF FLUID INTAKE AND OR
PROFUSE FLUID LOSSES
( eg. ANOREXIA, CANNOT DRINK &
MEAL, PATOLOGIC T G I, HEMORRHAGE,
VOMITUS, DIARRHEA, EVAPORATION OR
THIRD-SPACE LOSSES )
HEMODYNAMIC PROFILE : DECREASED
CO, DECREASED LEFT VENTRICULAR
FILLING PRESSURE, INCREASED SVR
MANAGEMENT OF HYPOVOLEMIC
SHOCK
STEPS A, B, C
RESTORATION OF INTRAVASCULAR
VOLUME WITH KOLLOID OR KRISTALLOID
TARGET : NORMAL BP, PULSE & ORGAN
PERFUSION (e g. adequate urine output)
PRINCIPLES IN FLUID RESUSCITATION :
- RAPID (to normovolumia)
- CLOSED TO THE KIND OF DEFICITE
FLUID
- USE THE AVAILABLE FLUID
CARDIOGENIC SHOCK
OBSTRUCTION TO CARDIAC
FILLING
CAUSA : CARDIAC TAMPONADE,
TENSION PNEUMOTHORAX,
MASSIVE PULMONARY EMBOLI
HEMODYNAMIC PROFILE :
DECREASED CO, VARIABLE LEFT
VENTRICULAR FILLING PRESSURE,
INCREASED SVR
MANAGEMENT OF OBSTRUCTIVE
SHOCK
STEPS A, B, C
RELIEF OF OBSTRUCTON
(PERICARDIOCENTESIS, PLEURAL
/THORACAL PUNCTION & WSD )
MAINTENANCE OF NORMOVOLEMIA
INOTROPES & VASOPRESSOR HAVE A
MINIMAL ROLE
DIURETICS SHOULD BE AVOIDED
Spesial notice :
SHOCK IS ONE OF CRITICALLY ILL,
LIFE THREATENING
SHOULD BE TREATED PROMPTLY,
WITH RESUSCITATION
THE PROGNOSIS IS CORRELATED
WITH TIME
CAUSA & PATOPHYSIOLOGY MAY
BE COMPLICATED, THEREFORE
THE MANAGEMENTS SHOULD BE
ADJUSTED CLOSELY
Alhamdulillahirobbilala
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