Circulatory Shock power point presentation

Circulatory shock

1. Shock Branday , October 22, 2013

2. You are asked to see a 65 year old man who was brought to the ER by ambulance. He looks pale and his peripheries are cold and clammy. On examination his pulse rate is 60/min, BP 70 / 45 mm Hg. His central venous pressure is elevated. The most likely diagnosis is: Septic shock Cardiogenic shock Anaphylactic shock Hypovolaemic shock

3. A 26 year-old male is admitted unconscious to the emergency room 1 hour after involvement in a road traffic accident. There is no external bleeding but there are multiple abrasions over the left side of the head and the left lower chest and abdomen. Blood pressure is 100/60 mm Hg. and pulse rate is 134/minute This clinical picture is best explained by: cerebral oedema intracranial haemorrhage intra abdominal haemorrhage multiple rib fractures Fat embolism syndrome

4. Circulatory Shock Definition Pathophysiology Types Clinical Features Principles of Treatment

5. Electric Shock Neurogenic Shock Cardiogenic Shock Spinal Shock Anaphylactic Shock Culture Shock Septicaemic Shock Shock Syndrome Haemorrhagic Shock Shock Therapy Burn Shock Endotoxic Shock Hypovolaemic Shock Circulatory Shock

6. Circulatory Failure Clinical syndrome resulting from the effects of inadequate tissue perfusion Impairment of blood flow to the tissues Acute Emergency

7. Basics of the Circulatory System Volume … Pressure ……………….. Capacitance …… Resistance ……………………….. Flow ………….

8. Effects of Impaired Perfusion Skin Metabolic (lactic) acidosis Lungs Brain Kidneys Gut (low flow state)

9. Common Signs and Symptoms Weak, rapid pulse Cold, clammy skin Hypotension (low blood pressure) Hyperventilation (over-breathing) Cyanosis (grayish-blue mucous membranes) Oliguria (decreased urine flow) Mental changes (anxiety and confusion)

10. Circulatory Shock low pressure  reduced flow  inadequate perfusion inadequate perfusion  tissue hypoxia  anaerobic metabolism  acidosis  cell damage Basic causes Loss/Reduction of circulating volume Reduced cardiac output (pump ‘failure’) Loss of vaso -motor tone (Capacity vs volume)

11. Loss/Reduction of circulating volume Hypovolaemic Shock Haemorrhage Fluid depletion Circulatory Shock External Internal

12. Signs and Symptoms General Features Weak, rapid pulse Cold, clammy skin Hypotension (low blood pressure) Oliguria (decreased urine flow) Mental changes (anxiety and confusion) Plus normal/low JVP/CVP Index of Suspicion (injury/burn, source of fluid loss)

13. Circulatory Shock Reduced cardiac output Cardiogenic Cardiac failure … Pump failure Cardiac tamponade …………………………………. Tension pneumothorax …………  Venous return  reduced cardiac output

14. Signs and Symptoms General Features Weak, rapid pulse Cold, clammy skin Hypotension (low blood pressure) Oliguria (decreased urine flow) Mental changes (anxiety and confusion) Plus Elevated JVP/CVP Index of Suspicion (H/O MI, penetrating chest injury, # ribs)

15. Circulatory Shock Loss of vaso -motor tone (Capacity vs volume) Septicaemic Anaphylactic/ Neurogenic

16. Signs and Symptoms General Features (early stages) Rapid pulse (may be high volume) Skin may be warm Hypotension (low blood pressure) Oliguria (decreased urine flow) Mental changes (anxiety and confusion) Plus Normal/low JVP/CVP Index of Suspicion (Source of infection, drug/blood administration)

17. Summary Hypovolaemic Haemorrhage /Fluid depletion Cardiogenic Cardiac failure, Cardiac tamponade , Tension pneumothorax Septicaemic Exotoxins and Endotoxins Anaphylactic/ Neurogenic Allergic (Drugs/transfusion) Spinal

18. Treatment General measures Position Warmth Establish IV access O 2 Administration Specific Stop external bleeding Replace fluids Identify/treat internal bleeding Monitor Clinical (blood pressure, pulse, peripheries) Conscious state Urinary output

19. You are asked to see a 65 year old man who was brought to the ER by ambulance. He looks pale and his peripheries are cold and clammy. On examination his pulse rate is 60/min, BP 70 / 45 mm Hg. His central venous pressure is elevated. The most likely diagnosis is: Septic shock Cardiogenic shock Anaphylactic shock Hypovolaemic shock

20. A 26 year-old male is admitted unconscious to the emergency room 1 hour after involvement in a road traffic accident. There is no external bleeding but there are multiple abrasions over the left side of the head and the left lower chest and abdomen. Blood pressure is 100/60 mm Hg. and pulse rate is 134/minute This clinical picture is best explained by: cerebral oedema intracranial haemorrhage intra abdominal haemorrhage multiple rib fractures Fat embolism syndrome