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SHOCK
DEFINITION
physiologic
state characterized
by a significant reduction of
systemic tissue perfusion,
resulting in decreased oxygen
delivery to the tissues
Inadequate
perfusion
cellular dysfunction
organ dysfunction
Causes
Cardiogenic
Hypovolemic
Distributive
(vasodilatory )
Obstructive (e.g
pulmonary embolism
tensin pneumothorax)
Cardinal features
Hypotension
Approach to patient
ABCs
Vital
signs
BP: repeat BP to make sure of
the reading
PR and rhythm :both
tachyarrythmia and
bradyarrythmias can be
associated with hypotension
Tachycardia can be associated
with any cause of shock
Approach to patient
Wide
Approach to patient
Tachypnea
can be
compensatory mechanism for
metabolic acidosis due to tissue
hypoperfusion
Assessment
and
resuscitation occur
simultaneously
Recent
Food
Skin
rash/ itching
Management
Rapid
assessment and
early resuscitation is
of paramount
importance
Time
is tissue
Delaying management
>> poor outcome
Management
Maintain
airway
Give
supplementary
oxygen if required
Consider
intubation if
extreme distress
Elevate the feet of
bed
IV access and
Management
Blood
test
CBC
Basic screening
bicarbonate
Anion gap
Coagulation profile
Blood grouping
Blood culture
Cardiac enzymes
Lactic acid
Management
CXR
ECG
Echocardiograph
Management
Management
needs to
be individualized
according to type of
shock
Generally IV fluid bolus
can be good initial
management for all
types of shock (need to
be caution in
cardiogenic)
Management (individulazied)
Hypovolemia
IV
Management (individulazied)
Anaphylactic
shock
>>> subcutaneous or IM
epinenphrince (0.5-1 ml )
+\- anithistamine and
corticosteroids
Cardiogenic
shock
use of inotropes
DC shock if unstable
tachyarrythmia
Management (individulazied)
Obstructive
Removal
of obstruction
PE thrombolysis
Tension Pneumothorax
Pericardial tamponade
Management
Monitoring
response to
treatment using
parametrs
Blood pressure
Urine output (need
insertion of foleys
catheter )
Consciousness level
Invasive monitoring
such as CVP and intra-
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