This is chapter 39 Care of Patients with Shock Ok shock. When we talk about shock we are really referring to the ability of the body to oxygenate and perfuse. This chapter probably fits well after talking about the respiratory system in detail when we are talking about the difference oxygenation and ventilation. Shock in reference to is termed or refers to a whole body response and when we talk about the different types of shock there are, we really will see where that whole body response really falls into play with whatever particular category of shock we are referring to. It is very important to understand that shock is a syndrome, we always talk about how time is of the essence. Very minute, very small changes are something you need to know about as far as terms in assessment, things that you need to pick up on early I should say because they could be that simple when they are early on. I have seen patients who have had diagnosis with shock, and not look probably what most of us typically think of when we think about shock. Patients can look very healthy, their vital signs can look relatively stable and things like that. Then on the other extreme you can have patients that of course need mechanical ventilation, very high volumes of oxygen, very large amount of fluid, antipyretics, things like that. So it’s really going to be dependent upon time and when the intervention actually is made, how they fare, how well they do. So any problem that would impair oxygen delivery to tissues and/or organs can start the syndrome of shock and can of course lead to life threatening emergency. So again it is very important to pick up on those minute details, the earlier the better so you can respond to them appropriately. Perfusion. Of course we all know about what perfusion means, the ability of the body to get perfused or oxygenated, volume to tissues. So some organs as you know now can tolerate longer periods of hypoxemia such as what? What organs can tolerate longer periods of hypoxemia? Those of course are termed your non-vital organs such as your gut, we talked about that in great detail already prior to this lecture. Tissue and organ perfusion are going to be related to MAP which of course is mean arterial pressure . You know that when you have a BP, a systolic and diastolic on most of you are digital machines that can record that will record, they will also give you a MAP in which an ideal MAP is about 65, you will see some physicians write orders based on their MAP vs. a systolic or diastolic BP when we are talking about, particularly when we are talking about the treatment of shock. They will write orders to titrate perhaps vasopressors to a MAP of 60 or 65. Really is going to be depending on where that patient is in their treatment process in regards to shock. They’ll titrate according to that instead of trying to titrate to a systolic or diastolic BP. Your MAP, there is a formula for it that you don’t have to know, I am not even
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- hypovolemic shock, Sepsis