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A messy on call
Mr James Age 48 Works as head lad in racing Vomited Seen at home and is drowsy but also noted that he has some coffee grounds in his vomit
Questions What does the story suggest? What might have caused this? Can you think of possible causes?
Admitted to hospital Seen in Accident department Examination Slightly yellow Dupytren’s contracture Spider naevi Abdomen – looks bloated Tip of spleen is felt
Questions What are the causes of the clinical signs? Why is his spleen enlarged?
Questions What is portal hypertension and what are the effects? How can you tell clinically
Sudden deterioration Collapses Low blood pressure Very drowsy Passes very smelly and black stools
Questions What is this called? Why has he collapsed?
Then Massive vomit 2 litres of bright red fresh blood BP now just palpable Carotid pulse 120 Cannot feel radial pulse Sweating
Questions What might have happened now? What would you need to do to help him? What investigations would you arrange in the emergency department? What test might he need now?
Oliguria What does this mean? Why does this occur? What is the risk if this is not treated?
Shock What do we mean by shock? What are the main types of shock?
WHAT IS SHOCK? Inadequate Tissue Perfusion
Symptoms of Shock Anxiety /Nervousness Dizziness Weakness Faintness Nausea & Vomiting Thirst Confusion Decreased UO Hx of Trauma / other illness Vomiting & Diarrhoea Chest Pain Fevers / Rigors SOB General SymptomsSpecific Symptoms
Signs of Shock Pale Cold & Clammy Sweating Cyanosis Tachycardia Tachypnoea Confused / Agitated Unconscious Hypotensive Stridor / SOB
Circulatory Homeostasis BP = CO X PVR CO – Cardiac Output PVR – Peripheral Vascular resistance Tissue perfusion is driven by blood pressure
What makes up blood volume Plasma RBCs WBCs Platelets
What Alters Blood Volume? Haemorrhage Plasma Loss Redistribution of Extracellular Volume
Heart Rate Heart rate increases as a compensatory response to Shock Rarely you get High Output failure Heart rate too fast to allow adequate refilling of heart between beats
Peripheral Vascular Resistance PVR regulated by ARTERIOLAR tone. Dilatation opens Arteriovenous beds & increases volume of circulatory system
What Alters PVR? Circulation cytokines & Inflammatory mediators (e.g. Histamine) Endotoxins Drugs (e.g. Nitrates)
Types of Shock Hypovolaemic Cardiogenic Redistributive
Hypovolaemic Volume Loss Blood loss -Haemorrhage Plasma Loss-Burns / Pancreatitis ECF Loss- V&D
Cardiogenic Pump Failure May be due to inability of heart to Contact Inability of heart to pump blood
Redistributive Decreased Peripheral Vascular Resistance Septic Shock Spinal / Neurogenic Shock ANAPHYLACTIC shock
SHOCK. Objectives Understand what shock is Understand what shock is Define types of shock Define types of shock Understand Pathophysiology of shock Understand.
SHOCK Alnasser Abdulaziz Alomari Mohammed Alhomoud Homoud.
SHOCK. What is shock? Shock is a life-threatening medical condition as a result of insufficient blood flow throughout the body. Shock often accompanies.
Shock. Important formulas Stroke Volume = End dyastolic volume – End systolic volume Cardiac output = Stroke volume x Heart rate Blood pressure = Cardiac.
1 Shock Terry White, RN. 2 SHOCK Inadequate perfusion (blood flow) leading to inadequate oxygen delivery to tissues.
Shock It is a sudden drop in BP leading to decrease cardiac output and decrease tissue perfusion. Symptoms and signs: Patient may or may not be conscious.
Describe shock List the causes of shock Describe the types of shock & their causes Describe the compensatory & decompensatory stages of shock Recognize.
SHOCK. 2 What is Shock? A condition of insufficient supply of blood reaching body tissues Certain degree of shock is found in most illness or trauma.
Chapter 9 Shock. Chapter 9: Shock 2 Objectives List signs and symptoms of shock. State the steps in the emergency medical care of a patient with signs.
CIRCULATORY SHOCK Lecture by Dr.Mohammed Sharique Ahmed Quadri Assistant professor,Physiology.
CLARA AND SARAH Shock. Learning Outcomes Define shock List the categories of shock Explain the physiological consequences of shock Compare physiological.
Shock Presented by Dr Azza Serry. Learning objectives Definition Pathophysiology Types of shock Stages of shock Clinical presentation management.
Shock Part 3: Chapter 9. Body Functions…. 3 conditions are needed to maintain adequate blood flow in the body: The heart must be working well An.
Shock. Definition Failure of circulation, that leads to inadequate tissue perfusion. Despite the compensatory mechanisms tissue hypoxia is developed.
Shock WCS Teaching Evening. What is shock? Acute failure of circulation resulting in impaired or absent perfusion to tissues and subsequent insufficient.
1 Shock Pakistan ICITAP. Learning Objectives Learn how shock occurs Know different types of shock Identify signs and symptoms of shock Demonstrate.
Circulatory SHOCK MAP = CO * TPR CO = SV * HR SV = EDV - ESV.
Describe shock List the causes of shock Describe the compensatory & decompensatory stages of shock Recognize the signs & symptoms of shock.
SHOCK. SHOCK Shock is a critical condition that results from inadequate tissue delivery of O2 and nutrients to meet tissue metabolic demand. Shock does.
Blood Transfusion in Acute Trauma Prof. W. O. Mwanda.
Shock. Outlines Definitions Signs and symptoms of shock Classification General principles of management Specific types of shock.
Shock Chapter 23 page 678 Shock State of collapse and failure of the cardiovascular system Leads to inadequate circulation Without adequate blood flow,
Lecture - 12 DR ZAHOOR ALI SHAIKH 1. We will discuss SHOCK under the following headings - DEFINATION - CLASSIFICATION - CLINICAL PRESENTATION - COMPENSATORY.
1 Shock and Bleeding Temple College EMS Professions.
Pages LEQ: When caring for a shock victim, how does the type of shock determine the treatment?
FLOW THROUGH TUBES Phil Copeman. Where is the largest pressure drop in the systemic circulation? Between the arteries- arterioles.
Chapter 11 Bleeding Shock. Bleeding & Shock Some Facts –Trauma is the leading cause of death for persons aged 1 to 44. –A vital part of trauma care is.
SHOCK Dr.Mohammed Sharique Ahmed Quadri Assistant Prof.Physiology Almaarefa College.
Bleeding and Shock Chapter 15. Blood Blood is the only tissue that flows throughout the body Carries oxygen & nutrients to all parts of the body Transports.
Shock. Shock Evaluation & Management Definition of Shock A condition that occurs when tissue perfusion with oxygen becomes inadequate. Hypoxia.
4 collapsed patients. Shock Shock is a profound haemodynamic and metabolic disturbance characterised by failure of the circulatory system to maintain.
Bleeding and Shock Bleeding Control of bleeding Shock Care for Shock.
Lecture 7 Shock. Definition of Shock It is a condition in which systemic blood pressure is inadequate to provide perfusion to the vital organs. 2.
1 Shock. 2 Shock refers to an abnormality of the circulatory system in which there is inadequate tissue perfusion due to a relatively or absolutely inadequate.
15.4 Providing First Aid for Shock Pages LEQ: When caring for a shock victim, how does the type of shock determine the treatment?
1 Chapter 23 and 24 Valvular problems and circulatory shock.
Shock and Anaphylaxis Chapter 37 Written by: Melissa Dearing – LSC-Kingwood.
1 Bleeding and Shock Pipes, pump, and fluid…really, it’s that simple!
Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 32 Shock.
SHOCK Ariel G. Bentancur, MD Emergency Department, Sheba Medical Center, Israel.
Chapter 7 Shock. Shock (1 of 2) Perfusion Adequate blood and oxygen are provided to all cells in body Circulatory system failure Not enough oxygenated.
Cardiovascular Emergencies CHAPTER 18. Cardiac emergencies are the most common medical emergencies in the U.S., with over 600,000 deaths each year...
Hemodynamic Disorders. Fluid Distribution ~60% of lean body weight is water ~2/3 is intracellular ~1/3 is extracellular (mostly interstitial) ~5% of total.
Shock: Cycle “A” Refresher Shock Nature’s prelude to death 2008 Cycle “A” OEC Refresher.
SHOCK Sudden collapse of circulation is called shock and is one of the most formidable conditions in clinical practice Sudden collapse of circulation is.
Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ International Trauma Life Support for Prehospital.
Chapter 9 Shock: A State of Hypoperfusion. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 2 Overview Hypoperfusion.
PTC shock Lt. col. Dr. Zaman Ranjha Associate prof. of Surgery.
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