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Shock - Core Lecture Series Shock Daniel J Riskin MD...

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Core Lecture Series - Shock Daniel J. Riskin, MD September 9, 2007
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Outline Definition Epidemiology Physiology Classes of Shock Clinical Presentation Management Controversies
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Definition A physiologic state characterized by Inadequate tissue perfusion Clinically manifested by Hemodynamic disturbances Organ dysfunction
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Epidemiology Mortality Septic shock – 35-40% (1 month mortality) Cardiogenic shock – 60-90% Hypovolemic shock – variable/mechanism
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Pathophysiology Imbalance in oxygen supply and demand Conversion from aerobic to anaerobic metabolism Appropriate and inappropriate metabolic and physiologic responses
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Pathophysiology Cellular physiology Cell membrane ion pump dysfunction Leakage of intracellular contents into the extracellular space Intracellular pH dysregulation Resultant systemic physiology Cell death and end organ dysfunction MSOF and death
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Physiology Characterized by three stages Preshock (warm shock, compensated shock) Shock End organ dysfunction
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Physiology Compensated shock Low preload shock – tachycardia, vasoconstriction, mildly decreased BP Low afterload (distributive) shock – peripheral vasodilation, hyperdynamic state
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Pathophysiology Shock Initial signs of end organ dysfunction Tachycardia Tachypnea Metabolic acidosis Oliguria Cool and clammy skin
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Physiology End Organ Dysfunction
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