Shock WCS Teaching Evening

What is shock? Acute failure of circulation resulting in impaired or absent perfusion to tissues and subsequent insufficient oxygen provision to cells.

Five Main types Hypovolaemic Cardiogenic Mechanical Septic Anaphylactic

Causes of Hypovolaemic shock Obvious blood loss (external) Internal blood loss, any major source of internal bleeding MASSIVE vomiting and/or diarrhea

Pathophysiology BASICALLY: Lost circulating volume, less blood goes into heart, less blood therefore gets pumped out of the heart, therefore BP drops. END RESULT? Oxygen delivery impaired, cells are gradually doomed

Signs and Symptoms Cold pale clammy skin. Poor cap. Refill Tachycardia BP – early is increased, later on drops Tachypnoea Oligo/Anuria Confusion, restlessness, anxiety, dizziness Switch to Anaerobic metabolism, results in lactic acid production and acidosis

Management Oxygen, replace lost fluid FIX UNDERLYING CAUSE

Cardiogenic Usually due to MI, heart can no longer pump blood Backlog of blood builds up in lungs: RV failure - JVP Dyspnoea Crackles/wheeze Pulmonary oedema

Diagnosis and Management History, ECG, Trop T, angiography Morphine, Oxygen, Nitrates, Aspirin Thrombolysis Fluids or diuretics?

Mechanical Shock Tension pneumothorax & Cardiac tamponade: prevent filling of heart PE: Overloading of RV and hypovolaemia of LV All present with features of shock, fix underlying cause

Septic Shock Infection of the blood results in systemic inflammatory response and mass vasodilation – fluids leaks out. Tachycardia Tachypnoea Hypotension Fever OR Hypothermia WCC >12 or <4

Septic Shock Early on – warm (vasodilated peripheries), as condition progresses becomes cold. Rigors are common.

SEPSIS SIX FBC High flow oxygen Fluid resus Urine output Blood culture & serum lactate High dose empirical antibiotics Administer if sepsis is SUSPECTED. Treat as septic until proven otherwise. Multi organ failure and mortality rates are very high

Anaphylactic Shock IgE mediated – type I hypersensitivity Allergen stimulates IgE to bind mast cells which then degranulate and release histamine. Vasodilation and increased capillary permeability.

Anaphylactic Shock Acute, within 30 mins Erythema, oedema Tachycardia, hypotension BRONCHOSPASM, OBSTRUCTIVE SWELLING Vomiting & Diarrhoea Adrenaline and oxygen. Fluids if needed, steroids and antihistamines for support.