An Overview of Circulatory Failure
Transcript of An Overview of Circulatory Failure
Shock
ACUTE CIRCULATORY FAILURE
INADEQUATE TISSUE PERFUSION
Cellular damage Cellular dysfunction Failure of major organ systems
Maintained by arterial blood pressure (MAP)
MAP = SVR × CO
Aqua Asif
Classification
SHOCK
COLD WARM
MAP = SVR × ↓CO MAP = ↓SVR × CO
Cardiogenic Hypovolaemic Obstructive
Septic Anaphylactic NeurogenicHaemorrhagic Non- haemorrhagic
Aqua Asif
Pump fa
ilure
E.g. Congesti
ve
heart fa
ilure
/
acute m
yoca
rdia
l infa
rctio
n
2Hyp
otensio
n
This is
picked up b
y baro
rece
ptors
→ they t
ry to
counte
r this.
..
3Vaso
const
rictio
n
This th
en redire
cts blood to
the
vital o
rgans →
cold
extre
miti
es
4Decr
eased ve
nous retu
rn
Blood ends
up backin
g up in
the
pulmonary
vess
els → leadin
g to
pulmonary
oedema
Cardiogenic
1
Aqua Asif
Intra
vasc
ular volu
me
E.g. PPH, t
raum
a, varic
eal bleeds
/// fluid
loss
(D&V, b
urns)
2Decr
eased ve
nous retu
rn
If th
ere’s
less in
trava
scular v
olum
e,
venous r
eturn
will
also d
rop and...
3Decr
eased ca
rdiac o
utput
Simila
r to
card
iogenic sh
ock,
periphera
l vaso
constr
iction occ
urs
4Vaso
const
rictio
n
This th
en redire
cts blood to
the
vital o
rgans →
cold
extre
miti
es
Hypovolaemic
1
Aqua Asif
Physica
l obst
ruct
ion
E.g. te
nsion
pneumoth
orax,
card
iac ta
mponade, P
E
2Decr
eased p
ump fu
nctio
n
If th
e heart is
preve
nted fro
m
pumpin
g pro
perly…
3Decr
eased ca
rdiac o
utput
Simila
r to
th
e oth
er ty
pes,
periphera
l vaso
constr
iction occ
urs
4Vaso
const
rictio
n
This th
en redire
cts blood to
the
vital o
rgans →
cold
extre
miti
es
Obstructive
1
Aqua Asif
Sepsis
E.g. infe
ctive endoca
rditi
s, SA,
menin
gitis,
pyelonephrit
is...
2M
acrophage act
ivatio
n
IL-1, IL
-6, T
NFα re
leased, a
long with
nitric oxid
e...
3Vaso
dilatio
n
This th
en causes p
atients
to appear
warm and flush
ed...
4Thro
mboplast
in
Inte
resti
ngly,
this
activate
s th
e
coagulatio
n cascade → leadin
g to
dissem
inate
d
intra
vasc
ular
coagulatio
n
Septic
1
Aqua Asif
Inju
ry to
the C
NS
E.g. spin
al cord
traum
a, TBI,
intra
cere
bral h
aemorrh
age
2Loss
of sym
pathetic
tone
Usually
the sy
mpath
etic sy
stem
stim
ulates c
ardiac outp
ut...
3In
crease
d para
sym
pathetic
Inste
ad, th
e para
sym
pathetic
syste
m w
ill dom
inate
...
4Vaso
dilatio
n
Incre
ased para
sym
pathetic
action
will lead to
perip
heral v
asodila
tion
→ warm
and flushed!
Neurogenic
1
Aqua Asif
Wors
t alle
rgic
react
ion
E.g. peanuts…
those
darn
peanuts
can b
e deadly.
..
2Ty
pe 1 hyp
ersensit
ivity
This leads t
o IgE-m
ediated re
lease
of antib
odies...
3M
ast ce
lls
Mast
cell a
ctivatio
n leads t
o release
of hist
amin
e and bra
dykin
in...
4Vaso
dilatio
n
This th
en causes p
atients
to appear
warm and flush
ed...
Anaphylactic
1
Aqua Asif
Acute Kidney Injury
Pre-renal
● Hypovolaemia
● Sepsis
● Low cardiac output
Renal
● Ischaemic injury○ Hypoxia
○ Hypoperfusion
Postrenal
Kidneys can’t function without adequate perfusion
AKI can lead to hyperkalaemia and pulmonary oedema
Aqua Asif
Assessment
Circulation
ASSESS TREAT
CHECK REQUEST MONITOR INVESTIGATE MANAGE
HYPOTENSIVE?
HAEMORRHAGE?
TRAUMA?
BLOODS
CANNULATE
BLOOD PRESSURE
CAP REFILL TIME
PULSE ECG CATHETERISE
URINE OUTPUT
Aqua Asif
Classification
SHOCK
COLD WARM
MAP = SVR × ↓CO MAP = ↓SVR × CO
Cardiogenic Hypovolaemic Obstructive
Septic Anaphylactic NeurogenicHaemorrhagic Non- haemorrhagic
Aqua Asif