1 Shock. 2 Shock refers to an abnormality of the circulatory system in which there is inadequate...
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Transcript of 1 Shock. 2 Shock refers to an abnormality of the circulatory system in which there is inadequate...
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Shock
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Shock
Shock refers to an abnormality of the circulatory system in which there is
inadequate tissue perfusion due to a relatively or absolutely inadequate cardiac
output.
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Hypovolemic shock Hypovolemic shock refers to a medical or
surgical condition in which rapid fluid loss results in multiple organ failure due to
inadequate circulating volume and subsequent inadequate perfusion. Most
often, hypovolemic shock is secondary to rapid blood loss (hemorrhagic shock).
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Pathophysiology
The human body responds to acute hemorrhage by activating the following major
physiologic systems: the hematologic, cardiovascular, renal, and neuroendocrine
systems.
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1- The hematologic system
activating the coagulation cascade. contracting the bleeding vessels. platelets are activated.
→ Formation of a blood clot.
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2- The cardiovascular system increasing the heart rate. increasing myocardial contractility. constricting peripheral blood vessels. redistributing blood to vital organs (brain,
heart, and kidneys) and away from skin, muscle, and GI tract.
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3- The renal system
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4- The neuroendocrine system ↑ ADH secretion in → ↑ reabsorption of water
and salt
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Causes
TraumaticRelated
VascularRelated
GI Related
Pregnancy Related
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Clinical Presentation
Hypotension. Rapid pulse. Cold, pale, clammy skin. Intense thirst. Rapid respiration. Restlessness. ↓ Urine volume.
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Do not rely on systolic BP as the main indicator of shock; this practice results in
delayed diagnosis. Compensatory mechanisms prevent a significant decrease in
systolic BP until the patient has lost 30% of the blood volume. More attention should be paid to the pulse, respiratory rate, and skin
perfusion. Also, patients taking beta-blockers may not present with tachycardia, regardless
of the degree of shock.
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Types of Hypovolemic
Shock
HemorrhagicShock
Traumatic Shock
SurgicalShock
BurnShock
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Treatment
Three goals exist in the emergency department treatment:(1) maximize oxygen delivery. (2) control further blood loss.(3) fluid resuscitation.
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Drug therapy
The goals of pharmacotherapy are to reduce morbidity and prevent complications.
Drug Category: Antisecretory agents
These agents have vasoconstrictive properties.
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Follow up
Complications:
Neurologic sequelae Death
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Prognosis
The prognosis is dependent on the degree of volume loss.