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Shock Types

This document discusses different types of shock and their treatment. It defines shock and describes three main types - cardiogenic, hypovolemic, and distributive shock. Cardiogenic shock results from cardiac pump failure, hypovolemic shock from intravascular volume loss, and distributive shock from diminished systemic vascular resistance. The document uses case studies to demonstrate recognition and treatment of each shock type, emphasizing fluid resuscitation, identifying and reversing the underlying cause, and supporting organ perfusion through appropriate vasopressors or inotropes. Early intervention is key to survival.

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430 views25 pages

Shock Types

This document discusses different types of shock and their treatment. It defines shock and describes three main types - cardiogenic, hypovolemic, and distributive shock. Cardiogenic shock results from cardiac pump failure, hypovolemic shock from intravascular volume loss, and distributive shock from diminished systemic vascular resistance. The document uses case studies to demonstrate recognition and treatment of each shock type, emphasizing fluid resuscitation, identifying and reversing the underlying cause, and supporting organ perfusion through appropriate vasopressors or inotropes. Early intervention is key to survival.

Uploaded by

Muqeet76
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Shock Management

Ahmad ALI

Objectives
Understand the definition of the three
different types of shock
Be able to recognize the different types of
shock in patient scenarios
Understand and apply treatment
guidelines for the different types of shock

What is Shock?
Shock is the physiologic state
characterized by significant reduction of
systemic tissue perfusion, resulting in
decreased tissue oxygen delivery.
Tissue perfusion is dependent on SVR and CO
Imbalance between oxygen delivery and
oxygen consumption which leads to cell death,
end organ damage, multi-system organ failure,
and death
Gaieski et al. 2009 (Online accessed 22 August 2013)
URL: http://lijhs.sandi.net/faculty/rtenenbaum/ap-biologyfolder/Links/Shock.utd.pdf

Three Types of Shock


Cardiogenic
Hypovolemic
Distributive
Septic
Anaphylactic
Neurogenic

Combined

Case Study
Mrs. C is a 61yo F who presents to ED
complaining of fatigue and SOB. She has
significant PMHx: DM, obesity, HTN. Husband
also states she has become slightly confused.
Vitals: HR 46, BP 68/32, RR 23, SpO2 95% ,
Afebrile.
Labs: WBC 8.1, Hgb 12.1, BUN 12, Creat 1.0,
Troponin 3.1, BG 121.
EKG shows ST elevation in II, III, aVF

What kind of shock does this patient have?

A. Cardiogenic
B. Hypovolemic
C. Distributive

Cardiogenic Shock

Shock caused as a result of cardiac pump


failure
Results in a decrease in CO
SVR is increased in an effort to compensate
to maintain organ perfusion
Causes:
Myocardial Infarction
Arrythmias (Atrial fibrillation, ventricular tachycardias,
bradycardias, etc)
Mechanical abnormalities (valvular defects)
Extracardiac abnormalities (PE, HTN, tension
Medscape Reference. 1994 (Online accessed 22 August 2013)
pneumothorax)
URL: http://emedicine.medscape.com/article/152191treatment#showall

What information do you have to suggest


that Mrs. C has cardiogenic shock?
A. Hypotension
B. Evidence of MI
C. Altered Mental
Status
D. All of the above
E. Both A. and B.

Treatment of Cardiogenic Shock


Correct hypotension:
Fluid resuscitation to correct hypovolemia
Inotropic or Vasopressor support:

Dobutamine
Milrinone
Norepinephrine
Dopamine
Epinephrine

Oxygenation
If MI MONA, Heparin, and Revascularization
If arrthymia correct arrthymia
If extracardiac abnormality reverse or treat cause

Case Study
Mr. H is a 18yo M who presents to ED after
suffering a MCC into a tree. He was
unhelmeted and has an obvious left femur fx.
He was intubated for a GCS of 8 in the field
and given 1L NS en route for hypotension.
Vitals: HR 145, BP 71/38, Intubated with
SpO2 100%, Afebrile.
Labs: WBC 12.3, Hgb 6.7, Plts 72, INR 2.1.
Traumagram shows Grade III liver lac.

What kind of shock does this patient have?

A. Cardiogenic
B. Hypovolemic
C. Distributive

Hypovolemic Shock
Shock caused by decreased preload due
to intravascular volume loss (1/5 of blood
volume)
Results in decreased CO
SVR is typically increased in an effort to
compensate
Causes:
Hemorrhagic trauma, GI bleed, hemorrhagic
pancreatitis, fractures
FluidMedscape
loss induced
Diarrhea, vomiting, burns
LLC. 2013 (Online access on 22 August 2013)
URL: http://emedicine.medscape.com/article/760145treatment#2

What information do you have to suggest


that Mr. H has hypovolemic shock?
A. Recent trauma
B. WBC 12.3
C. Hgb 6.7
D. All of the above
E. Both A. and C.

Treatment of Hypovolemic
Shock

Maximize oxygen delivery


Control further blood loss
Tourniquets
Surgical intervention

Fluid resuscitation
NS fluid boluses
Blood product administration

Case Study
Mr. S is a 59yo M presents to ED with
worsening abdominal pain and N&V
He is POD#8 s/p ex-lap, SBR with primary
anastamosis for chronic SBO at OSH
Vitals: HR 128, BP 78/45, RR28, SpO2 94%
on 4L NC, Fever 103.1
Labs: WBC 20.1, Hgb 9.5, BUN 34, Creat 2.1
CT scan of ABD shows anastamotic leak

What kind of shock does this patient have?


A. Cardiogenic
B. Hypovolemic
C. Distributive

Distributive Shock
Shock as a result of severely diminished
SVR
CO is typically increased in an effort to
maintain perfusion
Subtypes:
Septic secondary to an overwhelming infection
Anaphylactic secondary to a life-threatening
allergic reaction
Neurogenic secondary to a sudden loss of the
Gaieski et al. 2009 (Online accessed 22 August 2013)
autonomic
nervous system function
URL: http://lijhs.sandi.net/faculty/rtenenbaum/ap-biologyfolder/Links/Shock.utd.pdf

What information do you have to suggest


Mr. S has distributive shock?
A. SpO2 94% on 4 L
NC
B. Anastamotic leak
on CT scan
C. WBC 20.1
D. All of the above
E. Both B. and C.

Treatment of Septic Shock


Resuscitate
30cc/kg of NS bolus

Identify Source
Pan cultures
CT scan
Line removal
Foley removal
Surgical exploration

Antibiotics

Dellinger, R et al. Surviving Sepsis Campaign: International Guidelines


for Management of Severe Sepsis and Septic Shock:2012, 41: 580-637,
2013.

Treatment of Anaphylactic
Shock
Remove offending agent
Establish an airway and return circulation
Pharmacologic support:
Epinephrine reverses peripheral vasodilation, dilates bronchial
airways, increases myocardial contractility, and suppresses
histamine/ leukotriene release
Antihistamine (benadryl) may help counter histamine-mediated
vasodilation and bronchoconstriction
Corticosteroids (hydrocortisone) may help shorten reaction
Bronchodilators
Soar, J et al. 2013 (Online Accessed on 22 August 2013)
URL: http://www.resus.org.uk/pages/reaction.pdf

Treatment of Neurogenic Shock


Establish an airway to maintain adequate
oxygenation and ventilation
Fluid resuscitation for MAP>65mmHg
Inotropic support
Dobutamine
Dopamine

Atropine for severe bradycardia


High dose methyl prednisolone therapy
Emergency Medicine. 2009 (Online Accessed on 22 August 2013)
URL:
http://emergencymed.wordpress.com/2009/03/11/neurogenic-

All three types of shock can


occur at the same time to have
a combined shock picture.

Summary
Survival and outcomes improve
with early perfusion, adequate
oxygenation, and identification
with appropriate treatment of
the cause of shock.

Questions?

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