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SHOCK- Basic Principles in Surgery.pptx

The document provides an overview of shock, including its definition, types, etiology, and pathophysiology. It details clinical features, investigations, and treatment strategies, emphasizing the urgent need for recognition and intervention to prevent irreversible organ dysfunction. Various shock causes are explained, alongside management approaches for specific situations such as hemorrhagic and septic shock.

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AN OVRVIEW Dr.B.Selvaraj MS;Mch;FICS; “Surgical Educator” Malaysia SHOCK BASIC PRINCIPLES
SHOCK Objectives  Definition  Types  Etiology  Pathophysiology  Stages  Clinical features- Symptoms & Signs  Investigations  Treatment  Prognosis  Treatment Algorithm
SHOCK- Definition  Shock is defined as a state of cellular and tissue hypoxia due to either reduced oxygen delivery, increased oxygen consumption, inadequate oxygen utilization, or a combination of these processes.  This most commonly occurs when there is circulatory failure manifested as hypotension ie, reduced tissue perfusion  Shock is initially reversible but must be recognized and treated immediately to prevent progression to irreversible organ dysfunction.  "Undifferentiated shock" refers to the situation where shock is recognized but the cause is unclear
SHOCK- Types  Hypovolemic  Cardiogenic  Obstructive - Tension pneumothorax - Massive pulmonary embolism - Cardiac tamponade  Distributive - Septic - Anaphylactic - Neurogenic
SHOCK- Etiology
SHOCK- Etiology Hypovolemic Shock- Causes  Hemorrhage - External including GIT - Internal # Chest # Abdomen # Pelvis # Retroperitoneum # Long bones  Vomiting  Diarrhoea  Diuresis  Burns
SHOCK- Etiology Cardiogenic Shock- Causes  Myocardial infarction  Myocardial contusion  Myocarditis  Cardiac arrythmias - Unstable tachy-arrythmias - Unstable brady-arrythmias  Inotropic drugs overdosage - Beta blockers - Calcium channel blockers
SHOCK- Etiology Obstructive Shock- Causes  Tension pneumothorax  Cardiac tamponade  Massive PE
SHOCK- Etiology Distributive Shock- Causes  Septic shock  Anaphylactic shock  Neurogenic shock
SHOCK- Pathophysiology
SHOCK- Pathophysiology Hypovolemic Shock
SHOCK- Pathophysiology Septic Shock
SHOCK- Pathophysiology Cardiogenic Shock Important facts  BP= CO x SVR  CO= HRx SV  SV is volume of blood pumped by the heart per contraction. This is decided by preload, myocardial contractility and afterload.  Preload- is the ventricular wall tension at the end of diastole.  Afterload is the ventricular wall tension at the end of systole.
SHOCK- Pathophysiology Neurogenic Shock
SHOCK- STAGES
SHOCK- Clinical Features Symptoms  Assessment of severity - Dyspnea - Confusion - Light-headedness - Drowsiness - Oliguria/anuria  Symptoms of the cause Signs  Airway - May be compromised by reduced conscious level  Breathing: Hypoxia secondary to - Airway compromise - Kussmal’s brathing  Hyperventilation to compensate for metabolic acidosis  Circulation: - Cold & pale extremities - Prolonged capillary refill time CRT > 2secs - Tachycardia - Oliguria/Anuria  Disability: - Confusion - Drowsiness - Unconciousness
SHOCK- Investigations  Blood including blood gas to check pH and lactate  ECG & CXR  CVP, PCWP, CO & SVR  Echocardiogram  In trauma patients - Pelvic X-ray - CT- TAP - e-FAST scan
SHOCK- Treatment  Assess the patient from an ABCDE perspective  Maintain a patent airway  Use manoeuvres, adjuncts, supraglottic or definitive airways as indicated and suction any sputum or secretions  Deliver high flow oxygen 15L/min via reservoir mask to keep sats over 94%  Attach monitoring - Pulse oximetry and non-invasive blood pressure - Three-lead cardiac monitoring  Request 12 lead ECG and portable CXR  Obtain large-bore intravenous (IV) access and take bloods including blood gas to check pH and lactate  Fluid resuscitation IV  Urethral catheterisation and fluid balance monitoring aiming for a urine output >0.5 ml/kg/hour  If BP fails to respond consider referral to HDU/ICU for  Central line insertion with central venous pressure (CVP) and central venous oxygen saturation (ScvO2) monitoring  Arterial line insertion and invasive arterial BP monitoring  Vasopressor and/or inotrope infusion Initial management of shock
SHOCK- Treatment Further management of shock Identify and treat the cause  Haemorrhagic shock  Identify the source(s) of bleeding and achieve haemorrhage control e.g. direct compression, pelvic binder, splinting of long bone fractures, surgical ligation of bleeding vessels  Restoration of adequate circulating volume  Cross-match blood and activate the major haemorrhage protocol  Transfuse O negative blood initially, followed by type-specific and fully cross-matched blood as soon as it is available; aim for permissive hypotension  Correct coagulopathy by transfusion of platelets, FFP & cryoprecipitate as appropriate  RBC: FFP ratio should be between 1:1 and 1:2, the optimum ratio is uncertain.The key is to give FFP early with RBC. Cryo if fibrinogen<1.5.  Antibiotics and source control for septic shock  Adrenaline 0.5 mg intramuscular (IM) for anaphylactic shock  Needle thoracocentesis and intercostal chest drain insertion for tension pneumothorax  Pericardiocentesis and thoracotomy for cardiac tamponade  Thrombolysis for massive PE  Synchronised direct current (DC) cardioversion for unstable tachyarrhythmias  Pacing for unstable bradyarrhythmias
SHOCK- PROGNOSIS
SHOCK- Treatment
SHOCK- Treatment
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