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Good Morning!. February 18, 2011. Types of Shock. Hypovolemic Inadequate blood volume Distributive Inappropriately distributed blood volume and flow Cardiogenic Insufficient CO caused by poor myocardial function Obstructive Obstructed flow (into or out of the heart). Septic Shock.

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Good Morning!

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  1. Good Morning! February 18, 2011

  2. Types of Shock • Hypovolemic • Inadequate blood volume • Distributive • Inappropriately distributed blood volume and flow • Cardiogenic • Insufficient CO caused by poor myocardial function • Obstructive • Obstructed flow (into or out of the heart)

  3. Septic Shock February 18, 2011

  4. Shock: Defined • Critical condition • Inadequate delivery of oxygen to the tissues to meet metabolic demand • Often characterized by inadequate perfusion

  5. Shock • Consequences • Tissue hypoxia • Anaerobic metabolism • Accumulation of lactic acid, carbon dioxide • Irreversible cell damage • Death • Acute: cardiovascular collapse • Delayed: multiple-organ system failure

  6. Severity of Shock • Compensated vsDecompensated??? • DECOMPENSATED = HYPOTENSIVE

  7. Severity of Shock • Compensatory mechanisms: • Tachycardia • Increased contractility • Increased SVR • Failure of compensatory mechanisms results in hypotension (decompensated shock)

  8. Keep in Mind • Severe shock • Low BP • Normal BP • Automated BP devices are not reliable with weak/absent distal pulses

  9. Assessment • General Appearance • Ill, listless, decreased response to environment • Airway • Associated with level of consciousness

  10. Assessment • Breathing • Quiet tachypnea • metabolic acidosis • Nasal flaring/retractions • intrinsic respiratory distress • Cardiogenic or obstructive shock • Pulse oximetry • Unreliable with poor perfusion

  11. Assessment • Circulation • Skin: mottled, pale, diaphoretic, cyanotic • Heart: murmur, gallop, distant • Lungs: crackles • Extremities: prolonged cap refill, diminished pulses • End-organ function: brain, kidneys

  12. Circulation • Tachycardia • Early sign of shock • Hypotension • Late and often sudden sign of decompensation • May progress quickly to cardiac arrest • Cap Refill • Extremity above level of heart • Context of other signs

  13. Questions • What volume of fluid should you bolus? • How fast? • What is to goal fluid administration w/in first hour? • Warm vs Cold: What is the difference? • How does treatment vary?

  14. Questions • How does volume resuscitation differ for: • Cardiogenic shock? • Tamponade? • Pulmonary Embolism? • When should you consider hydrocortisone?

  15. See Septic Shock Flowchart

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