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  • D. P. Laporta MD SMBD-JGH Dept of Adult Critical Care

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    gabriel_febby
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    This document outlines shock, including its definition, causes, effects of ineffective treatment, assessment, and clinical approach. Shock is defined as a profound disturbance in circulation and metabolism leading to inadequate organ perfusion. Causes include hypovolemic, cardiogenic, obstructive, and distributive shock. Without effective treatment, shock can lead to multiple organ dysfunction, infections, and death. Proper assessment involves classifying shock and determining fluid or blood product needs. Sublingual capnometry is highlighted as a new noninvasive method to diagnose and quantify shock severity by measuring tissue hypercarbia. The clinical approach is to rapidly restore tissue perfusion through ABC stabilization, ICU consultation, treating the underlying cause, and following priorities for fluid

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    Shock

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    This document outlines shock, including its definition, causes, effects of ineffective treatment, assessment, and clinical approach. Shock is defined as a profound disturbance in circulation and metabolism leading to inadequate organ perfusion. Causes include hypovolemic, cardiogenic, obstructive, and distributive shock. Without effective treatment, shock can lead to multiple organ dysfunction, infections, and death. Proper assessment involves classifying shock and determining fluid or blood product needs. Sublingual capnometry is highlighted as a new noninvasive method to diagnose and quantify shock severity by measuring tissue hypercarbia. The clinical approach is to rapidly restore tissue perfusion through ABC stabilization, ICU consultation, treating the underlying cause, and following priorities for fluid

    Copyright:

    © All Rights Reserved
    Scarica in formato PPT, PDF, TXT o leggi online su Scribd
    Segnala contenuti inappropriati
    9 visualizzazioni40 pagine

    D. P. Laporta MD SMBD-JGH Dept of Adult Critical Care

    Caricato da

    gabriel_febby
    This document outlines shock, including its definition, causes, effects of ineffective treatment, assessment, and clinical approach. Shock is defined as a profound disturbance in circulation and metabolism leading to inadequate organ perfusion. Causes include hypovolemic, cardiogenic, obstructive, and distributive shock. Without effective treatment, shock can lead to multiple organ dysfunction, infections, and death. Proper assessment involves classifying shock and determining fluid or blood product needs. Sublingual capnometry is highlighted as a new noninvasive method to diagnose and quantify shock severity by measuring tissue hypercarbia. The clinical approach is to rapidly restore tissue perfusion through ABC stabilization, ICU consultation, treating the underlying cause, and following priorities for fluid

    Copyright:

    © All Rights Reserved
    Scarica in formato PPT, PDF, TXT o leggi online su Scribd
    Segnala contenuti inappropriati
    di 40

    D. P.

    Laporta MD
    SMBD-JGH
    Dept of Adult Critical Care

    SHOCK - OUTLINE
    DEFINITION
    CAUSES

    EFFECTS

    OF INEFFECTIVE
    TREATMENT
    ASSESSMENT
    CLINICAL APPROACH

    CASE

    CASE

    CASE

    CASE

    CASE

    CASE

    SHOCK CASES

    1. post Cardiac Surgery


    - same day
    - 1 week postop

    2. in MVA victim
    3. In young male with Crohn s
    disease found febrile in shock
    4. In drug addict, hospital worker

    SHOCK DEFINITION

    CAUSES
    EFFECTS OF INEFFECTIVE TREATMENT
    ASSESSMENT
    CLINICAL APPROACH

    DEFINITION

    A profound disturbance of the circulation


    and metabolism, leading to
    inadequate perfusion of vital organs,
    necessary to maintain homeostasis

    SHOCK

    DEFINITION

    CAUSES

    EFFECTS OF INEFFECTIVE TREATMENT


    ASSESSMENT
    CLINICAL APPROACH

    HYPOPERFUSED STATES
    RV
    Venous

    PVR

    LV
    Arterial

    (capacitance)

    (resistance)

    EF End-Diastolic Volume
    SVR

    BP 60/30

    Hypovolemic

    HR 140/min
    CVP 0
    Lactate 10

    Cardiogenic

    BP 70/50

    HR 130/min
    CVP 18
    Lactate 12

    Obstructive

    BP 70/50

    HR 140/min
    CVP 15
    Lactate 12

    VTED

    OAD
    DLD

    Distributive

    BP 70/40

    HR 140/min
    CVP 5
    Lactate 12

    SHOCK

    DEFINITION
    CAUSES

    EFFECTS

    OF INEFFECTIVE
    TREATMENT

    ASSESSMENT
    MEASUREMENT
    CLINICAL APPROACH

    EFFECTS OF INEFFECTIVE TREATMENT

    MISERY !!!
    MODS
    PO2/FiO2 ratio
    Serum creatinine
    Platelet count
    Glasgow coma score
    Serum bilirubin
    Pressure-adjusted heart rate
    (hr x CVP/MAP)

    INFECTION

    SHOCK

    DEFINITION
    CAUSES
    EFFECTS OF INEFFECTIVE TREATMENT

    ASSESSMENT

    MEASUREMENT
    CLINICAL APPROACH

    SHOCK: asssessment
    Class

    1&2
    vs 3&4
    needs blood or crystalloid ?

    Sublingual capnometry:
    A new noninvasive measurement for diagnosis and
    quantitation of severity of circulatory shock
    Max Harry Weil MD, PhD, FCCM - CCM 1999

    hypercarbia is a universal indicator of critically reduced


    tissue perfusion.

    Sublingual capnometry:
    A new noninvasive measurement for diagnosis and
    quantitation of severity of circulatory shock

    Sublingual capnometry:
    A new noninvasive measurement for diagnosis and
    quantitation of severity of circulatory shock

    Sublingual capnometry:
    A new noninvasive measurement for diagnosis and
    quantitation of severity of circulatory shock

    P SL CO2
    provides a prompt
    indication of the
    reversal of tissue
    hypercarbia
    when circulatory
    shock is reversed

    SHOCK

    DEFINITION
    CAUSES
    EFFECTS OF IEFFECTIVE TREATMENT
    MEASUREMENT

    CLINICAL

    APPROACH

    SHOCK: an EMERGENCY !!!

    GOAL:
    RAPIDLY RESTORE TISSUE PERFUSION

    Recognize

    it !!!

    Immediate stabilization: ABC

    . SHOTGUN approach
    ICU & Surgical consultation

    Treat the cause

    Management priorities
    in hypoperfused states

    Priority # Physiology to Intervention


    improve
    1

    Volume

    Fluids

    Pressure

    Vasopressor

    Flow

    Inotrope

    Parameter to target
    CVP 10-15

    PAC
    targets
    DO2

    Low Sao2
    See CXR
    Low SV, DO2
    High HR,
    Resistances

    DO2

    Low BP, SV,


    Resistances

    SBP? 100 or within 20-25


    torr
    MBP ? 80 of patient's Nl
    Signs of perfusion

    Avoid

    BP potency: Dopamine...NEVasopressin/Phenylephrine

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