Hypovolemic shock

hypoglycemic shock

1. بسم الرحمن الرحیم وزارت صحت عامه ریاست اکمال تخصص آمریت آموزش وانکشاف دیپارتمنت جراحی صدری Supervised By Sp.Dr.Rahmani Prepared by Dr.Anush Shock

2. Shock Objective : 1.Defination 2.epidimology 3.pathophysiology 4.stage of shock 5.type of shock 6.general clinical future 7.hypovolemic shock

3. quastions Shcok indix : pr / sbp Cardiac indix : Monify indix shock:main art pressure / sbp

4. Definition of shock Shock defined as inadequate delivery of oxygen and nutrients to maintain normal tissue and cellular function. (Schwartz )

5. Epidemiology Shock occurs in 2% of all hospitalized patients in USA . Death usually occur due to complications rather than during hypotensive phase. Mortality in septic shock as low as 3% in previously health children and 6-9% in children with chronic illness .

6. Pathophysiology of shock Hypovolemic shock effective circulating blood volume Hemorrhage Truma venous return to heart Surgery cardiac output Burns blood flow Dehydration supply of oxygen Septic shock Anoxia Cardiogenic shock shock

7. Stages of shock Non=progressive (Initial, Compensated reversible )Shock Progressive Decompensated shock Decompensated (Irreversible)Shock

8. Type Of Shock Hypovolemic shock Cardiogenic shock Distributive shock (tension pneumothorax ,cardiac tamponed ) Obstructive shock Septic shock

9. General clinical features Hypotension (SBP <100mmhg) Tachycardia>100/min Cold Rapid, Shallow respiration Drowsiness,confusion,irritability Oliguria(urine output<30 ml/h Multi organ failure

10. Hypovolemic shock Definition: I s an emergency condition in which severe blood and fluid loss make the heart unable to pump enough blood to the body . This type of shock can cause many organs to stop working .

11. P athophysiology Hemorrhage from small venules and veins (50%) Decreased filling of right heart Decreased filling of pulmonary vasculature Decreased f illing of left atrium and ventricle Left ventricular stroke volume decreases Drop in atrial blood pressure and tachycardia Poor perfusion to pulmonary arteries Cardiac depression and pump failure

12. Risk factors for hypovolemic shock

13. Classification of hypovolemic shock Hemorrhagic : Truma Gastrointestinal Bleeding Non Hemorrhagic : External fluid loss Diarrhea Vomiting Polyuria burns Anaphylaxis

14. Classification of acute blood loss

15. Compensatory Mechanisms Adrenergic discharge Hyperventilation Vasoactive hormones (angiotensin , vasopressin , epinephrine ) Re-absorption of fluid from interstitial tissue Resorption of fluid from intercellular to extracellular space Renal conservation of body water and electrolyte.

16. Signs and symptoms Restlessness Hypotension Cool Rapid and shallow respiration Hypothermia Thirst and dry mouth Distracted look in the eye

17. Clinical monitoring Blood pressure Respiration Urine output ECG Swan- Ganz Catheter Cardiac output Venous oxygen level Vascular pressure

18. Diagnosis E valuation (agitation, cold Ext,tachycardia,hypotention)(25-30%B.Loss) Physical Exam: Ab,Chest ,Pelvic Hemorrhage (external , intrathoracic , intra Ab, Introperitoneal and long bon fracture) . Chest X-Ray Pelvic radiography Diagnostic ultrasound Diagnostic peritoneal lavage

19. Management objective : A: Increase cardiac output B: increase tissue perfusion The plan of action should be based on : A: primary problem (stop bleeding) B: Adequate fluid replacement c : blood transfusion ( Hb = 7 to 9) d: improving myocardial contractility e: correcting acid-base disturbances

20. Cont.… Resuscitation Immediate control of bleeding (rest , pressure Peking and surgical methods)] Infusion of fluid is the fundamental treatment Crystalloids fluid Colloids fluid (after crystalloid) Drugs : 1.sedatives 2.chronotropic agent 3.inotropic agent

21. Thank you.