shock 050810
DESCRIPTION
shockTRANSCRIPT
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SHOCKMAHMUD
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OBJECTIVESIdentify the 4 main catogories of shock.Discuss goals of resuscitation in shock.Summarize the general principles of shock management.Describe the physiologic effects of vasopressor and inotropic agents.Discuss the differential diagnosis of oligouria.
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Case StudyA 25 years old women with no prioe history presents to the emergency departement complaining a cough productive of tenacious greenish yellow mucous. Vital signs are temperature 38,80C, heart rate 129/mnt, respiratory rate 27/min, and blood pressure 112/68 mmHg.What information is needed to determine if this patient has shock?What initial interventions are needed to stabilize the patient?
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I. INTRODUCTION
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II. Clinical alterations in shock
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III. Classification of shockHypovolemic CardiogenicHemorragic Myopatic (ischemic)Nonhemorragic Mechanical (valvular)Distributive ArrhytmicSepticAdrenal crisis ObstructiveNeurogenic (spinal shock) Massive pulmonary embolism Tension pneumothorax Cardiac tamponade Constriction pericarditis FCCS 2007
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Hemodynamic Profiles of shockType of shockHeart RateCardiac OutputVentricular FillingPressuresSystemic VascularResistencePulse PressureSVO2/ ScVO2
CardiogenicHypovolemicDtistributionObstructive
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Causes of Inadequate PerfusionInadequate pumpInadequate preloadPoor contractilityExcessive afterloadInadequate heart rateInadequate fluid volumeHypovolemiaInadequate containerExcessive dilationInadequate systematic vascular resistance
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Responses to ShockNormal compensation includes:Progressive vasoconstrictionIncreased blood flow to major organsIncreased cardiac outputIncreased respiratory rate and volumeDecreased urine output
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Cellular Response to ShockTissueperfusion
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Cardiogenic Shock CO
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Neurogenic Shock Sympathetic ToneOr Parasympathetic Tone
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Anaerobic? So What?InadequateCellularOxygenation