Hypovolemic shock
hemodynamics
HpDynamic Shock:
–CO
++ vascu resistance
++ O2 extraction, lactic acidosis
– Filling P° : Preload –
Hypovolemic shock
examples
Hemorrhage
Dehydration
Burns
Acute pancreatitis
Hypovolemic shock
complications
cardiac
myocardial Hpperfusion
Depressant drugs
liver Hpdyn shock
ischemia
centrilobular necrosis
++ transaminases
lungs ARDS, (IN)direct lung injury
kidneys Hpperfusion, actute tubular necrosis
coagulation DIC, thrombocyropenia
brain
intestinal ischemia, stress ulceration, intestinal necrosis, pancreatitis, reperfusion, bacterial translocation > sepsis
Cardiogenic shock
hemodynamics
HpDynamic Shock:
–CO (–contractility)
++ vascu resistance
++ O2 extraction, lactic acidosis
++ Filling P° : Preload ++
Afterload ++
prolonged capillary refill time
Cardiogenic shock
examples
Acute MI of LV
Cardiomyopathies
Severe valvular lesions
Cardiogenic shock
complications
cardiac
! reperfusion injury
liver HpDyn shock
ischemia
centrilobular necrosis
++ transaminases
lungs ARDS, (IN)direct lung injury
kidneys Hpperfusion, actute tubular necrosis
coagulation DIC, thrombocytopenia
brain
intestinal ischemia, stress ulceration, intestinal necrosis, pancreatitis, reperfusion, bacterial translocation > sepsis
Cardiogenic shock
Treatment
Treat cardiac Patho
Anemia: Cristalloids, Blood products
Improve contractility: Inotropes (Dobutamine)
Mechanical treatment
Counterpulsation baloon
ECMO
Implantable pumps
Obstructive shock
hemodynamics
HpDynamic Shock:
–CO
++ vascu resistance
++ O2 extraction, lactic acidosis
Afterload ++
Inflow: Impaired ventricular filling.
Outflow: – Ventricular compliance
Obstructive shock
examples
Tension pneumothorax
Cardiac tamponade
++ asthma (air trapping)
Constrictive pericarditis
PE
++ stenotic valves
Obstructive shock
complications
liver HpDyn shock
ischemia
centrilobular necrosis
++ transaminases
lungs ARDS, (IN)direct lung injury
kidneys Hpperfusion, actute tubular necrosis
coagulation DIC, thrombocytompenia
brain
intestinal ischemia, stress ulceration, intestinal necrosis, pancreatitis, reperfusion, bacterial translocation > sepsis
Distributive shock
hemodynamics
HPDynamic shock
CO [+]/–/++
– vascu resistance
[+] O2 extraction
Distributive shock
examples
Sepsis
Anaphylaxis
SIRS
Drug intox
Adrenal insufficiency
Neurogenic shock
Spinal shock
Distributive shock
complications
cardiac
– myocardial contractility
liver
kupfer cells, mediators.
intrahepatic cholestasis, Acalculus cholecystitis
lungs ARDS, (IN)direct lung injury
kidneys Hpperfusion, actute tubular necrosis
coagulation DIC, thrombocytopenia
brain
intestinal ischemia, stress ulceration, intestinal necrosis, pancreatitis, reperfusion, bacterial translocation > sepsis
Distributive shock
Treatment
Septic shock Golden hour
IV fluids
ATB
Vasopressors: Noradre, VasoP ; NOT adre
Inotropes: Dobutamine
Steroids (ssi hemodynamic instability, Adrenal insufficiency)
+/-
blood products (FFP in consumptive coagulopathies, PLT if bleeding risk)
mechanical ventilation (acute lung injury, ARDS)
…
Anaphylactic shock
Stop expposure
100% O2
IV fluids (cristalloids +/- colloids)
Addrenaline
IV antihistaminics
Bronchodilators
Steroids
+/- Vasopressin (ssi persistent HpT°)
