Download Types of Shock

Differential Diagnosis and Hemodynamic
Monitoring
By
Dr. Ishara Maduka M.B.B.S.(Colombo)
Shock is a Cardiovascular Derangement.
1. Deliver Oxygen and Metabolic Substrates
2. Remove Products of Cellular Metabolism
3. Thermoregulation
Definition:
A physiological state characterized by a significant,
systemic reduction in tissue perfusion, resulting in
decreased tissue oxygen delivery and insufficient
removal of cellular metabolic products, resulting in
tissue injury.
•Hypovolemic
•Septic/Inflammatory
•Cardiogenic (Intrinsic, compressive &
Obstructive)
•Neurogenic
•Anaphylactic
•Brachial systolic blood pressure: <110mmHg
•Sinus tachycardia: >90 beats/min
•Respiratory rate: <7 or >29 breaths/min
•Urine Output: <0.5cc/kg/hr
•Metabolic acidemia: [HCO3]<31mEq/L or base deficit>3mEq/L
•Hypoxemia: 0-50yr: <90mmHg; 51-70yr: <80mmHg;
>71yo<70mmHg;
•Cutaneous vasoconstriction vs. vasodilation.
•Mental Changes: anxiousness, agitation, indifference, lethargy,
obtundation
•Decreased preload->small ventricular end-diastolic
volumes -> inadequate cardiac generation of pressure
and flow
•Causes:
-- bleeding: trauma, GI bleeding, ruptured aneurysms,
hemorrhagic pancreatitis
-- protracted vomiting or diarrhea
-- adrenal insufficiency; diabetes insipidus
-- dehydration
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Signs & Symptoms: Hypotension, Tachycardia,
Oliguria, Low volume Pulses.
Markers: monitor UOP,CVP, BP, HR, Hct,CO,
lactic acid and PCWP
Treatment: ABCs, IVF (crystalloid), Transfusion
Stem ongoing Blood Loss
Patients on β-blockers, w/ spinal shock & athletes
may not be tachycardic
Mechanism: release of inflammatory mediators leading to
1. Disruption of the microvascular endothelium
2. Cutaneous arteriolar dilation and increased capillary
permeability
Causes:
1. Anaphylaxis, drug, toxin reactions
2. Trauma: crush injuries, major fractures, major burns.
3. infection/sepsis: G(-/+ ) speticemia, pneumonia,
peritonitis, meningitis, cholangitis, pyelonephritis,
necrotic tissue, pancreatitis, wet gangrene, toxic shock
syndrome, etc.
Signs:
Early– warm peripheries with vasodilatation, often
adequate urine output, febrile, tachypnoeic.
Late-- vasoconstriction, hypotension, oliguria,
altered mental status.
Mechanism: Intrinsic abnormality of heart -> inability to
deliver blood into the vasculature with adequate power
Causes:
1. Cardiomyopathies: myocardial ischemia, myocardial infarction,
cardiomyopathy, myocardiditis, myocardial contusion
2. Mechanical: cardiac valvular insufficiency, papillary muscle
rupture, septal defects, aortic stenosis
3. Arrythmias: bradyarrythmias (heart block), tachyarrythmias
(atrial fibrillation, atrial flutter, ventricular fibrillation)
4. Obstructive disorders: PE, tension peneumothorax, pericardial
tamponade, constrictive pericaditis, severe pulmonary
hypertension
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Characterized by high preload (CVP) with low CO
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Signs: Dyspnea, rales, loud P2 gallop, low BP, oliguria
Mechanism: Loss of autonomic innervation of the
cardiovascular system (arterioles, venules, small
veins, including the heart)
Causes:
1. Spinal cord injury
2. Regional anesthesia
3. Drugs
4. Neurological disorders
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Characterized by loss of vascular tone & reflexes.
Signs: Hypotension, Bradycardia, Accompanying
Neurological deficits.
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Sphyngmomanometry
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Pulse Oximeter
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Arterial Line
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Central Venous Line (Triple Lumen,
Pulmonary Artery Catheter)
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List the types of shock.
List the clinical features of shock.
Briefly explain the pathophysiology of each
type of shock.