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    D. P. Laporta MD SMBD-JGH Dept of Adult Critical Care

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    Kukhan Arjunan
    This document outlines shock, including its definition, causes, effects, assessment, and clinical approach. Shock is defined as a profound disturbance in circulation and metabolism leading to inadequate organ perfusion. The causes of shock include hypovolemic, cardiogenic, obstructive, and distributive types. Without effective treatment, shock can lead to multiple organ dysfunction and infection. Assessment of shock involves classifying its type and severity using measurements such as lactate, capillary refill time, and sublingual capnometry. The clinical approach is to rapidly restore tissue perfusion through ABC stabilization, treating the underlying cause, and targeting parameters like volume status, pressure, and flow.

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    D. P. Laporta MD SMBD-JGH Dept of Adult Critical Care

    Uploaded by

    Kukhan Arjunan
    41 views40 pages
    This document outlines shock, including its definition, causes, effects, assessment, and clinical approach. Shock is defined as a profound disturbance in circulation and metabolism leading to inadequate organ perfusion. The causes of shock include hypovolemic, cardiogenic, obstructive, and distributive types. Without effective treatment, shock can lead to multiple organ dysfunction and infection. Assessment of shock involves classifying its type and severity using measurements such as lactate, capillary refill time, and sublingual capnometry. The clinical approach is to rapidly restore tissue perfusion through ABC stabilization, treating the underlying cause, and targeting parameters like volume status, pressure, and flow.

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    shock. Manifestation

    Original Title

    Shock

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    This document outlines shock, including its definition, causes, effects, assessment, and clinical approach. Shock is defined as a profound disturbance in circulation and metabolism leading to inadequate organ perfusion. The causes of shock include hypovolemic, cardiogenic, obstructive, and distributive types. Without effective treatment, shock can lead to multiple organ dysfunction and infection. Assessment of shock involves classifying its type and severity using measurements such as lactate, capillary refill time, and sublingual capnometry. The clinical approach is to rapidly restore tissue perfusion through ABC stabilization, treating the underlying cause, and targeting parameters like volume status, pressure, and flow.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    41 views40 pages

    D. P. Laporta MD SMBD-JGH Dept of Adult Critical Care

    Uploaded by

    Kukhan Arjunan
    This document outlines shock, including its definition, causes, effects, assessment, and clinical approach. Shock is defined as a profound disturbance in circulation and metabolism leading to inadequate organ perfusion. The causes of shock include hypovolemic, cardiogenic, obstructive, and distributive types. Without effective treatment, shock can lead to multiple organ dysfunction and infection. Assessment of shock involves classifying its type and severity using measurements such as lactate, capillary refill time, and sublingual capnometry. The clinical approach is to rapidly restore tissue perfusion through ABC stabilization, treating the underlying cause, and targeting parameters like volume status, pressure, and flow.

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    D. P.

    Laporta MD SMBD-JGH Dept of Adult Critical Care

    SHOCK - OUTLINE
    DEFINITION CAUSES

    EFFECTS

    OF INEFFECTIVE TREATMENT ASSESSMENT CLINICAL APPROACH

    CASE

    CASE

    CASE

    CASE

    CASE

    CASE

    1. post Cardiac Surgery - same day - 1 week postop

    SHOCK CASES

    2. in MVA victim
    3. In young male with Crohn s disease found febrile in shock 4. In drug addict, hospital worker

    SHOCK DEFINITION

    CAUSES EFFECTS OF INEFFECTIVE TREATMENT ASSESSMENT CLINICAL APPROACH

    DEFINITION

    A profound disturbance of the circulation and metabolism, leading to inadequate perfusion of vital organs, necessary to maintain homeostasis

    SHOCK

    DEFINITION

    CAUSES

    EFFECTS OF INEFFECTIVE TREATMENT ASSESSMENT CLINICAL APPROACH

    HYPOPERFUSED STATES
    RV
    Venous
    (capacitance)
    PVR

    LV
    Arterial
    (resistance)

    EF End-Diastolic Volume
    SVR

    BP 60/30

    Hypovolemic

    HR 140/min
    CVP 0 Lactate 10

    Cardiogenic

    BP 70/50

    HR 130/min
    CVP 18 Lactate 12

    Obstructive

    BP 70/50

    HR 140/min
    CVP 15 Lactate 12

    VTED

    OAD
    DLD

    Distributive

    BP 70/40

    HR 140/min
    CVP 5 Lactate 12

    SHOCK

    DEFINITION CAUSES

    EFFECTS

    OF INEFFECTIVE TREATMENT
    ASSESSMENT MEASUREMENT CLINICAL APPROACH

    EFFECTS OF INEFFECTIVE TREATMENT

    MISERY !!!
    MODS
    PO2/FiO2 ratio Serum creatinine Platelet count Glasgow coma score Serum bilirubin Pressure-adjusted heart rate (hr x CVP/MAP)

    INFECTION

    SHOCK

    DEFINITION CAUSES EFFECTS OF INEFFECTIVE TREATMENT

    ASSESSMENT

    MEASUREMENT CLINICAL APPROACH

    SHOCK: asssessment
    Class

    1&2 vs 3&4 needs blood or crystalloid ?

    Sublingual capnometry:
    A new noninvasive measurement for diagnosis and quantitation of severity of circulatory shock
    Max Harry Weil MD, PhD, FCCM - CCM 1999

    hypercarbia is a universal indicator of critically reduced tissue perfusion.

    Sublingual capnometry:
    A new noninvasive measurement for diagnosis and quantitation of severity of circulatory shock

    Sublingual capnometry:
    A new noninvasive measurement for diagnosis and quantitation of severity of circulatory shock

    Sublingual capnometry:
    A new noninvasive measurement for diagnosis and quantitation of severity of circulatory shock

    P SL CO2 provides a prompt indication of the reversal of tissue hypercarbia when circulatory shock is reversed

    SHOCK

    DEFINITION CAUSES EFFECTS OF IEFFECTIVE TREATMENT MEASUREMENT

    CLINICAL

    APPROACH

    SHOCK: an EMERGENCY !!!

    GOAL:
    RAPIDLY RESTORE TISSUE PERFUSION

    Recognize

    it !!!

    Immediate stabilization: ABC

    . SHOTGUN approach
    ICU & Surgical consultation

    Treat the cause

    Management priorities
    in hypoperfused states
    Parameter to target
    CVP 10-15 SBP? 100 or within 20-25 torr MBP ? 80 of patient's Nl Signs of perfusion DO2

    Priority # Physiology to Intervention improve


    1 2 Volume Pressure Fluids Vasopressor

    PAC targets
    DO2

    Avoid
    Low Sao2 See CXR Low SV, DO2 High HR, Resistances Low BP, SV, Resistances

    Flow

    Inotrope

    BP potency: Dopamine...NEVasopressin/Phenylephrine

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