Dr. Abdullah M. Kaki, MB ChB, FRCPC

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Presentation transcript:

Dr. Abdullah M. Kaki, MB ChB, FRCPC Shock Dr. Abdullah M. Kaki, MB ChB, FRCPC Department of Anesthesia, Faculty of Medicine, King Abdulaziz University

Objectives of the Lecture To provide an up-to-date understanding of the types of shock To understand the current pathophysiology of shock To discuss some therapeutic options for shock

Definition French term , Choc (Le Dran- 1743) Systemic derangement in tissue perfusion leading to wide spread of cellular hypoxia and vital organs dysfunction.

37 yr male involved in RTA,(driver), brought to ER by Paramedics BP 90/50 mmHg, HR 120/min, RR 28/min Perfuse sweating, pallor, tenderness over chest & upper abdomen What is wrong with him? D Dx? What LAB investigation is required for the Dx? What is your plan for treatment?

52 yr Diabetic female patient admitted with foot ulcer for debridement 52 yr Diabetic female patient admitted with foot ulcer for debridement. 2 days later pt developed fever, confusion and they called you to assess the patient. What is your approach? What is plan for treatment?

22 yr male patient came to ER with renal colic, your colleague prescribed an antibiotic & pain killer for him. On administration of his medicine, he collapses. What is your approach?

75 year old female admitted to the hospital 4 days ago with chest pain, S.O.B., diagnosed as MI & was started. Early this morning the patient developed hypotension, tachycardia, SOB What is wrong with her?

Types of Shock Hypovolemic Distributive Obstructive Cardiogenic

Shock Features Septic Cardiogenic Hypovolemic Blood Pressure ↓ Shock Features Septic Cardiogenic Hypovolemic Blood Pressure ↓ Heart rate ↑ Respiratory rate Mentation Urine output Arterial pH Is cardiac out[put reduced? No Yes Pulse pressure Diastolic pressure ↓↓↓ Extremities/ Digits Warm Cool Nailbed return Rapid Slow Heart sounds Crisp Muffled Temperature ↑ or ↓ ↔ White cell count Site of infection + + - Is the heart too full? Symptoms/clinical context Sepsis/liver failure Angina / ECG Hemorrhage/dehydration Jugular venous pressure S3, S4, gallop rhythm + + + Respiratory crepitation Chest X-ray Normal Large heart, ↑upper lobe flow, pulmonary edema

Pathophysiology of Shock Oxygen Delivery: PaO2 Hb CO CO = SV X HR

Compensatory & Decompensatory Mechanisms Autonomic Nervous System Hormonal mechanism Peripheral Vascular system Myocardial Depression Transcapillary refill Down regulation of Catecholamines receptors

The mainstay of shock therapy Improving Oxygen Delivery: (by raising hemoglobin concentration, cardiac output, or arterial saturation). Reduce Oxygen Consumption. Identify and treat the precipitants of hypoperfusion.

Therapeutic Options Early Diagnosis Need for ICU Identification of Cause Prevention: *Aseptic Technique * Monitoring *Perioperative Antibiotics *Vaccination

Fluid Resuscitation Colloids vs Crystalloids Fluid replacement Augmentation of SV Fluid Inotropes Vasodilators

Future Directions Better Outcome: Advanced monitoring and ICU facilities. More patients: elderly, major surgeries, more infection & more invasive devices. Outlook is bright as we are unrevealing the secrets of shock.