Shock for General Surgery BDS final year \ ppt.pdf
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- 3. DEFINITION OF SHOCK 04 TABLEOF CONTENTS 06 03 PATHOPHYSIO- LOGY CLASSIFICATION MANAGEMENT 02 CLINICAL FEATURE 05 CONSEQUENCES 01
- 4. What is shock?? ●Shock is a systemic state of low tissue perfusion that is inadequate for normal cellular respiration. ● It is a life threatening condition where death may occur rapidly due to profound state of shock or be delayed due to the consequences of organ ischemia & reperfusion injury.
- 5. Hypovolemic Cardiogeni c Distributive Endocrine Classification ofshock Obstructive
- 8. Hypovolemic shock Hemorrhage Dehydration Excessivefluid loss Less fluid intake, sweating Traumatic injury, Hemorrhagic fever Vomiting, diarrhoea, urinary loss Third space loss Bowel obstruction, pancreatitis
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- 10. Obstructive shock Causes are- ●massive pulmonary embolus or air embolus ● severe pulmonary hypertension ● cardiac tamponde ● tension pneumothorax,,
- 11. Distributive shock Causes are- ●Septic shock ● Anaphylaxis ● Spinal cord injury
- 12. Endocrine shock Causes are- ●Hypo & hyperthyroidism ● Adrenal insufficiency, e.g. Addison’s disease
- 13. Pathophysiology of shock CellularMicrovascular Systemic
- 14. Cellular Cells switch to anaerobic metabolismdue to Oxygen deprivation Accumulation of lactic acid in blood produce systemic metabolic acidosis Failure of Na/K pump in cell membrane & cell organalle Lysosome releases autodigestive enzymes Cell lysis
- 15. Microvascular Hypoxia & acidosis activatesimmune (complement & prime neutrophils) & coagulation system Injury of capillary endothelial cell Damaged endothelium becomes leaky & allow fluid to leak out Tissue edema & exacerbation of cellular hypoxia
- 16. Systemic Cardiovascular: Decreased preload& afterload Compensatory baroreceptor mechanism activates Sympathetic activity increases Release of catecholamine in circulation Tachycardia & systemic vasoconstriction Respiratory: Metabolic acidosis & increased sympathetic response Increased respiratory rate & minute ventilation to increases CO2 excretion Renal: Decreased perfusion pressure Reduced glomerulus filtration & urine output Renin-angiotensis-aldosteron axis is stimulated Vasoconstriction & increase Na & Water reabsorption by kidney Endocrine: ● Vasopressin is released Vasoconstriction & resoprtion of water in renal collecting system ● Release of cortisol from adrenal cortex Increase Na & water reabsorption & sensitizing the cells to catecholamine
- 17. Stages of shock CompensatedDecompensated 01 Mild Moderate 02 03 04 05 Severe a)Central blood volume is maintained & preserve flow to vital organs b) Tachycardia & cool periphery found a)Progressive renal, respiratory & cvs decompensation b) BP is well maintained a) Initial tachycardia, tachypnoea, mild reduction in urine output b) BP is maintained although pulse pressure decreases a) Renal perfusion & BP falls b) Urine output dips below 0.5ml/kg per hour c) Patient is drowsy & mild confused a) Profound tachycardia & hypertension b) Urine output falls to zero c) Patient is unconscious
- 18. Stages of shock Compensated Stage(reversible through treatment) MildShock Moderate shock Severe shock(death occurs)
- 19. 15% 30-40% CRUCIAL FACTS!! Circulatoryloss can maintain compensatory mechanism Circulatory loss initiates fall in BP
- 20. Clinical Feature Mental confusion Rapidthready pulse Hypotension Tachycardia Cold clammy cyanotic skin Tachypnea Air hunger In early stage Sweating & restlessness In late stage Drowsiness Cyanosis Metabolic acidosis Aneuria Oliguria
- 21. Feature Compensated MildModerate Severe Lactic acidosis + ++ ++ +++ Urine output Normal Normal Reduced Aneuric Conscious level Normal Mild anxiety Drowsy Comatose Respiratory rate Normal Increased Increased Laboured Pulse rate Mild increase Increased Increased Increased Blood pressure Normal Normal Mild hypotension Severe hypotensio Features of shock- At a glance!
- 22. Consequences of shock 1.Unresuscitable shock: Patients who are in profound shock for a long period of time become unresuscitable. Here death is the inevitable result. 2. Multiple organ failure: Result of prolonged systemic ischemia & reperfusion injury is multi-organ failure. Organ Effect of organ failure Lung Acute respiratory distress syndrome Kidney Acute renal insuffiency Liver Acute liver insuffiency Clotting Coagulopathy(DIC) Cardiac CVS failure
- 24. -Bailey & Love'sShort Practice Of Surgery, 27Th Edition “Multiple organ failure currently carries a mortality of 60%, thus its prevention is vital by early aggressive identification & reversal of shock” Do you know???
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- 26. RESUSCITATION Is our wordof interest regarding management of shock
- 27. Clearing airways(by headtilt or chin lift) Oropharyngeal suction 1. Immediate Resuscitation is done by maintenance of respiration airway, adequate oxygenation & ventilation These are achieved by clearance of oropharyngeal suction, oxygen inhalation to maintain oxygen saturation, artificial respiration & endotracheal intubation
- 29. Blood Crystalloid Solutions Hartmann’s solution, Normal saline Colloid Albumin IVaccess through a short, wide bore catheter/ Cannula-18 & IV fluid is administered. Dextrose 1st line therapy 2.Fluid Resuscitation
- 30. 3. Dynamic fluidresponse: ❖ 250-500ml fluid is administered over 5-10 minutes & CVS responses such as heart rate, blood pressure, central venous pressure etc are measured. ❖ Patient can be divided into responders, transient responders & non-responders based on it. 4. Vasopressor & inotropic support: ❖ Vasopressor agent such as phenylephrin, noradrenaline are given in distributive shock. ❖ Inotropic agents such as Dobutamine are given in cardiogenic shock. Positive Inotropic Medication ↑Strength of heart muscle contraction ↓ ↑Stroke volume ↓ ↑Cardiac output ● Dobutamin ● Digoxin
- 31. 5. Monitoring patient: MinimumAdditional Heart Rate by ECG O2 saturation by pulse oxymetry Non-invasive blood pressure Hourly urine output measurements Central venous pressure Invasive blood pressure Cardiac output Base deficit
- 32. 6. Prevention ofrenal shut down by catheterization & diuretics if necessary 7. Correction of acidosis by IV infusion of 7.5% Sodium Bi-carbonate 8. Circulation maintained by raising of foot, which increase cerebral circulation Female catheterization Male catheterization Raising foot
- 33. ● Bailey &love’s Short Practice of Surgery 27th edition ● A concise textbook of surgery by S. Das 6th edition ● Photos- Google REFERENCES
- 34. CREDITS: This presentationtemplate was created by Slidesgo, including icons by Flaticon, and infographics & images by Freepik THANK YOU