Shock WCS Teaching Evening

What is shock? Acute failure of circulation resulting in impaired or absent perfusion to

tissues and subsequent insufficient oxygen provision to cells.

Five Main types Hypovolaemic

Cardiogenic

Mechanical

Septic

Anaphylactic

Causes of Hypovolaemic shock Obvious blood loss (external)

Internal blood loss, any major source of internal bleeding

MASSIVE vomiting and/or diarrhea

Pathophysiology BASICALLY:

Lost circulating volume, less blood goes into heart, less blood therefore gets pumped out of the heart, therefore BP drops.

END RESULT? Oxygen delivery impaired, cells are gradually doomed

Signs and Symptoms Cold pale clammy skin. Poor cap. Refill

Tachycardia

BP – early is increased, later on drops

Tachypnoea

Oligo/Anuria

Confusion, restlessness, anxiety, dizziness

Switch to Anaerobic metabolism, results in lactic acid production and acidosis

Management Oxygen, replace lost fluid

FIX UNDERLYING CAUSE

Cardiogenic Usually due to MI, heart can no longer pump blood

Backlog of blood builds up in lungs: RV failure - JVP Dyspnoea Crackles/wheeze Pulmonary oedema

Diagnosis and Management History, ECG, Trop T, angiography

Morphine, Oxygen, Nitrates, Aspirin

Thrombolysis

Fluids or diuretics?

Mechanical Shock Tension pneumothorax & Cardiac tamponade: prevent filling of heart

PE: Overloading of RV and hypovolaemia of LV

All present with features of shock, fix underlying cause

Septic Shock Infection of the blood results in systemic inflammatory response and mass

vasodilation – fluids leaks out.

Tachycardia

Tachypnoea

Hypotension

Fever OR Hypothermia

WCC >12 or <4

Septic Shock Early on – warm (vasodilated peripheries), as condition progresses becomes

cold.

Rigors are common.

SEPSIS SIX FBC

High flow oxygen

Fluid resus

Urine output

Blood culture & serum lactate

High dose empirical antibiotics

Administer if sepsis is SUSPECTED. Treat as septic until proven otherwise.

Multi organ failure and mortality rates are very high

Anaphylactic Shock IgE mediated – type I hypersensitivity

Allergen stimulates IgE to bind mast cells which then degranulate and release histamine.

Vasodilation and increased capillary permeability.

Anaphylactic Shock Acute, within 30 mins

Erythema, oedema

Tachycardia, hypotension

BRONCHOSPASM, OBSTRUCTIVE SWELLING

Vomiting & Diarrhoea

Adrenaline and oxygen. Fluids if needed, steroids and antihistamines for support.