shock surgery - SHOCK Objectives Objectives Understand what...

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Unformatted text preview: SHOCK Objectives Objectives Understand what shock is Define types of shock Understand Pathophysiology of shock Understand how to treat shock WHAT IS SHOCK? WHAT Inadequate Tissue Inadequate Perfusion Perfusion Symptoms of Shock Symptoms General Symptoms Anxiety /Nervousness Dizziness Weakness Faintness Nausea & Vomiting Thirst Confusion Decreased UO Specific Symptoms Hx of Trauma / other Hx illness illness Vomiting & Vomiting Diarrhoea Diarrhoea Chest Pain Fevers / Rigors SOB Signs of Shock Signs Pale Cold & Clammy Sweating Cyanosis Tachycardia Tachypnoea Confused / Aggiatated Unconscious Hypotensive Stridor / SOB Circulatory Homeostasis Circulatory Tissue perfusion is driven by blood pressure BP = CO X PVR CO – Cardiac Output PVR – Peripheral Vascular resistance Cardiac Output Cardiac CO = SV X HR This means that This BP= SV X HR X PVR Blood Pressure = Stroke Volume X Heart Rate X Peripheral Vascular Resistance Stroke Volume Volume of Blood pumped by the heart Volume during 1 cycle during What affects Stroke volume? Blood Volume MechanicalO bstruction Rhythm Problems Heart Muscle Damage Mechanical Obstruction Stroke Volume What makes up blood volume volume Plasma RBCs Platelets WBCs What Alters Blood Volume? What Haemorrhage Plasma Loss Redistribution of Extracellular Volume Heart Rate Heart Heart rate increases as a compensatory Heart response to Shock response Rarely you get Rarely High Output failure High Heart rate too fast to allow adequate refilling Heart of heart between beats of Peripheral Vascular Resistance Peripheral PVR regulated by PVR ARTERIOLAR tone. ARTERIOLAR Dilatation opens Dilatation Arteriovenous beds & increases volume of circulatory system What Alters PVR? What Circulation cytokines & Inflammatory Circulation mediators (e.g. Histamine) mediators Endotoxins Drugs (e.g. Nitrates) Types of Shock Types Hypovolaemic Cardiogenic Redistributive Hypovolaemic Hypovolaemic Volume Loss Blood loss -Haemorrhage Blood -Haemorrhage Plasma Loss -Burns / Pancreatitis -Burns Pancreatitis ECF Loss - V&D V&D Cardiogenic Cardiogenic Pump Failure May be due to May inability of heart to Contact Inability of heart to pump blood Redistributive Redistributive Decreased Peripheral Vascular Decreased Resistance Resistance Septic Shock Spinal / Neurogenic Shock ANAPHYLACTIC shock Pathophysiological Response Pathophysiological “Flight or fight response” Increased Catecholamine release Activation of Renin-Angiotensin system Increase glucocorticoid and mineralcorticoid Increase release release Activation of Sympathetic nervous system Treatment of Shock Treatment ABC Treatment of Shock Treatment Ensure Adequate Intravascular Volume Support Pump Anaphylactic Shock Anaphylactic Caused by a hypersensitivity reaction Caused to an allergen in a previously sensitised patient sensitised Common Allergens Common Nuts Bee / Wasp Stings DRUGS Common Features Common Angio-oedema Bronchoconstriction Vasodilatation and hypotension Urticareal rash Angio-oedema Angio-oedema Treatment Treatment RECOGNISE THE PROBLEM GET HELP ABC Treatment Treatment Ensure Airway is adequate Oxygen IV access early IV fluids ADRENALINE 0.5ml 1 in 1000 IM Bronchodilators Steroids SHOCK Clinical Scenarios 1) A 26 year old man with a comminuted closed fracture of the femur shaft undergoes intramedullary nail fixation. Two days post operatively, he develops a pyrexia, shortness of breath and tachycardia. Discuss the emergency management? 2) A 72 year old man develops sudden back pain and is brought to the emergency department with a swollen ,tense abdomen. He is tachycardic ,with a low volume pulse and low BP. Discuss the emergencymanagement? 3) A 72 year old man with an underlying prostate carcinoma sustains a femoral shaft fracture .He undergoes intramedullary nail fixation. At post operative day 7 he develops a shortness of breath ,hypotension and a tachycardia Discuss the emergency management? ...
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