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

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Presentation on theme: "Shock Dr. Abdullah M. Kaki, MB ChB, FRCPC Department of Anesthesia, Faculty of Medicine, King Abdulaziz University."— Presentation transcript:

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

2 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

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

4 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?

5 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?

6 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?

7 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?

8 Types of Shock Hypovolemic Distributive Obstructive Cardiogenic

9

10 Shock Features SepticCardiogenicHypovolemic Blood Pressure Heart rate Respiratory rate Mentation Urine output Arterial pH Is cardiac out[put reduced?NoYes Pulse pressure Diastolic pressure Extremities/ DigitsWarmCool Nailbed returnRapidSlow Heart soundsCrispMuffled Temperature or White cell count or Site of infection+ -- Is the heart too full?NoYesNo Symptoms/clinical contextSepsis/liver failureAngina / ECGHemorrhage/dehydration Jugular venous pressure S3, S4, gallop rhythm Respiratory crepitation Chest X-rayNormalLarge heart, upper lobe flow, pulmonary edema Normal

11 Pathophysiology of Shock Oxygen Delivery: PaO 2 Hb CO CO = SV X HR

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

13 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.

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

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

16 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.


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