Shock_-_FINAL_COPY

Shock_-_FINAL_COPY - Shock Pathophysiology, Classification,...

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Anand Kumar, MD Anand Kumar, MD Section of Critical Care Medicine Section of Infectious Diseases University of Manitoba, Winnipeg, Canada UMDNJ-Robert Wood Johnson Medical School Cooper Hospital, NJ Shock Shock Pathophysiology, Classification, and Pathophysiology, Classification, and Approach to Management Approach to Management
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Shock Shock Cardiogenic shock - a major component of the the mortality associated with cardiovascular disease (the #1 cause of U.S. deaths) Hypovolemic shock - the major contributor to early mortality from trauma (the #1 cause of death in those < 45 years of age) Septic shock - the most common cause of death in American ICUs (the 13th leading cause of death overall in US)
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Shock: Definitions Shock: Definitions Kumar and Parrillo (1995) - “The state in which profound and widespread reduction of effective tissue perfusion leads first to reversible, and then if prolonged, to irreversible cellular injury.”
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Shock: Classification Shock: Classification Hypovolemic shock - due to decreased circulating blood volume in relation to the total vascular capacity and characterized by a reduction of diastolic filling pressures Cardiogenic shock - due to cardiac pump failure related to loss of myocardial contractility/functional myocardium or structural/mechanical failure of the cardiac anatomy and characterized by elevations of diastolic filling pressures and volumes Extra-cardiac obstructive shock - due to obstruction to flow in the cardiovascular circuit and characterized by either impairment of diastolic filling or excessive afterload Distributive shock - caused by loss of vasomotor control resulting in arteriolar/venular dilatation and characterized (after fluid resuscitation) by increased cardiac output and decreased SVR
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Classification of Circulatory Shock Classification of Circulatory Shock Kumar and Parrillo, 2001 HYPOVOLEMIC Hemorrhagic Trauma Gastrointestinal Retroperitoneal Fluid depletion (nonhemorrhagic) External fluid loss - Dehydration - Vomiting - Diarrhea - Polyuria Interstitial fluid redistribution - Thermal injury - Trauma - Anaphylaxis Increased vascular capacitance (venodilatation) Sepsis Anaphylaxis Toxins/drugs
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Kumar and Parrillo, 2001 CARDIOGENIC Myopathic Myocardial infarction (hibernating myocardium) Left ventricle Right ventricle Myocardial contusion (trauma) Myocarditis Cardiomyopathy Post-ischemic myocardial stunning Septic myocardial depression Pharmacologic Anthracycline cardiotoxicity Calcium channel blockers Mechanical Valvular failure (stenotic or regurgitant) Hypertropic cardiomyopathy Ventricular septal defect Arrhythmic Bradycardia Tachycardia Classification of Circulatory Shock Classification of Circulatory Shock
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Kumar and Parrillo, 2001 Classification of Circulatory Shock Classification of Circulatory Shock EXTRACARDIAC OBSTRUCTIVE Impaired diastolic filling (decreased ventricular preload ) Direct venous obstruction (vena cava) - ntrathoracic obstructive tumors Increased intrathoracic pressure - Tension pneumothorax
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Shock_-_FINAL_COPY - Shock Pathophysiology, Classification,...

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