Understanding Shock Shock is a condition where there is inadequate tissue perfusion, leading to insufficient oxygen delivery and potential organ failure. It progresses through stages of compensation before reaching a refractory stage that can be fatal.
Types of Shock - Hypovolemic shock: Caused by blood loss or non-blood fluid loss, such as from GI bleeding, trauma, postpartum hemorrhage. - Compensatory mechanisms include increased systemic vascular resistance and heart rate but are limited due to low blood volume. - Clinical manifestations include decreased cardiac output, elevated heart rate (tachycardia), and abnormal hematocrit levels.
Complications of Hypovolemic Shock Hypovolemic shock can lead to complications like ischemia followed by necrosis if not reversed in time. Organ failure may occur due to prolonged inadequate tissue perfusion caused by the depletion of blood volume.
Hematocrit and Cyanosis High hematocrit indicates fluid loss, while low hematocrit suggests red blood cell loss. Cyanosis is a bluish cast of certain skin areas due to decreased tissue perfusion caused by low blood volume.
Treatment for Shock - Start with IV fluids to restore blood volume - Use crystalloids like normal saline or ringers lactate solution - Consider plasma volume expanders like albumin or hetastarch if needed - Prevent hypothermia and control hemorrhage
Problems with Protons Having a lot of protons leads to metabolic acidosis, which negatively affects the heart's contractile activity and heart rate. This can result in decreased blood pressure, cardiac output, and lactic acid buildup.
"How do you treat it?" - Treat the underlying cause (e.g., myocardial infarction) by performing angioplasty or using thrombolytics. - Provide oxygen and isotonic fluids to help circulate blood throughout the heart. - Administer vasopressors like epinephrine or dobutamine to increase contractility. - Use amber tone as a phosphodiesterase 3 inhibitor if refractory period is reached. - Consider intra-aortic balloon pump for cases requiring additional support.
Obstructive Shock: Tension Pneumothorax & Pericardial Tamponade Tension pneumothorax occurs when air accumulates in the pleural cavity due to an internal obstruction. It compresses the heart chambers and vessels, leading to restricted filling and ejection of blood. Signs include mediastinal/tracheal shift, hyperresonance on percussion exam, decreased breath sounds,and high jugular venous pressure Pericardial tamponade happens when excess fluid builds up within pericardium causing compression ontheheart.It resultsinrestrictedcardiacfillingandcanbeidentifiedbydistendedneckveins
Cardiac Compression Fluid accumulation in the heart compresses and squeezes it, making it difficult to fill with blood. This leads to decreased volume and pressure on the heart, causing problems with contraction.
Pericardial Tamponade 'Beck's triad' of symptoms: high jugular venous pressure, low blood pressure due to inadequate pumping of blood by the heart, muffled or distant heart sounds. Other effects include hypoxemia and respiratory distress.