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LAB. FINDINGS :
e.g. :
- METABOLIC ASIDOSIS FOR ALL KINDS OF SHOCK
- HEMOCONCENTRATION FOR HYPOVOLEMIC
SHOCK
- BACTERIEMIA FOR SEPTIC SHOCK
- TENSION (PNEUMOTHORAX WITH LUNG COLLAPS
AND MEDIASTINUM SHIFT ON CHEST X-RAY) FOR
OBSTRUCTIVE SHOCK
- CARDIOMEGALI OR ABNORMALITY OF CARDIAC
APPEARANCE IN CHEST X-RAY AND ECG FOR
CARDIAC SHOCK
II. BASIC PRINCIPLES
OF SHOCK MANAGEMENT
AIRWAY FREE
ADEQUATE BREATHING
( VENTILATE THE ALVEOLI, OPTIMIZED BLOOD
OXYGENATION, INCREASE O2 DELIVERY & TISSUE
OXYGENATION )
ADEQUATE CIRCULATION
(INCREASE CARDIAC OUTPUT & BLOOD PRESSURE
WITH FLUID, POSITIVE INOTROPES AND VASOPRESSORS
DEPEND ON THE CAUSA & PATHOPHYSIOLOGY)
SEARCH CAUSA AND TREAT PROMPLY
GUIDE OF TREATMENT WITH CLOSED MONITORING
GENERAL EARLY TARGET
IN SHOCK RESUSCITATION
COMPOS MENTIS
A & B NORMAL
C : BP SYSTOLE > 90 mmHg,
HR < 100 x/mnt
Cap. Refill < 2 sec.
warm extremities
FLUID : URINE PROD. > 0,5 cc/kg/hr
Face mask-valve-bag
III. MAJOR CATAGORIES OF SHOCK
1. HYPOVOLEMIC SHOCK
2. CARDIOGENIC SHOCK
3. DISTRIBUTIVE SHOCK
4. OBSTRUCTIVE SHOCK
HYPOVOLEMIC SHOCK
STEPS A, B, C
RESTORATION OF INTRAVASCULAR VOLUME
WITH KOLLOID OR KRISTALLOID
TARGET : NORMAL BP, PULSE & ORGAN
PERFUSION (e g. adequate urine output)
PRINCIPLES IN FLUID RESUSCITATION :
- RAPID (to normovolumia)
- CLOSED TO THE KIND OF DEFICITE FLUID
- USE THE AVAILABLE FLUID
CARDIOGENIC SHOCK
STEPS A, B, C
IMPROVE MYOCARDIAL FUNCTION
ARRHYTMIA SHOULD BE TREATED
PROMPTLY
INOTROPES iv. (Dobutamine, to increase
myocard contractility)
VASOACTIVE DRUGS iv. (In Case of low
SVR, vasoconstrictor to increase aortic diastolic
pressure, in case of high SVR : vasodilator)
INOTROPIC & VASOACTIVE DRUGS
ADRENALIN ISOSORBID
NOREPINEPHRINE DINITRAT (ISDN)
DOBUTAMINE & NTG
DOPAMINE (NITROGLYCERIN)
LANOXIN CAPTOPRIL
NOREPINEPHRINE
EPHEDRINE
PHENYLEPHRINE
DISTRIBUTIVE SHOCK
STEPS A, B, C
RELIEF OF OBSTRUCTON
(PERICARDIOCENTESIS, PLEURAL
/THORACAL PUNCTION & WSD )
MAINTENANCE OF NORMOVOLEMIA