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Shock (Clinical signs of shock (Inadequate perfusion
Sys BP <90
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Shock
Clinical signs of shock
Inadequate perfusion
- Sys BP <90
- Lactate <3
- Increased cap refill time
Brain
- Lethargy
- Agitation
- Somnolence
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Types of shock
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Cardiogenic
- Pump failure
- Rhythm abnormalities
- Valvular defects
- Obstruction to flow
Distributive
- Sepsis (commonest)
Anaphylaxis
- Neurogenic
- Liver failure
- Adrenal insufficiency
- Drugs and toxic exposures
Vasoactive drugs
- INOTROPES - increase the contractility of the heart by acting on BETA RECEPTORS
- VASOPRESSORS - cause vasoconstriction of the peripheral vasculature by acting on ALPHA RECEPTORS
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A state of circulatory failure characterised by tissue perfusion that is inadequate to meet the needs of the body
Identify and treat the cause!
- Homeostasis for bleeding
- Source control and antibiotics for sepsis
- Steroids / antihistamines for anaphylaxis
- Coronary intervention for acute MI
Optimising perfusion
- Ensure adequate oxygen saturations
- Ensure adequate ventilation
- FLUID RESUSCITATION
- Ensure adequate haemoglobin
Monitoring
- HR and RR trends
- Urine output
- Repeated ABG and lactate
- GCS monitoring
Treatment of shock on ICU
- Continous invasive monitoring for more accurate fluid resuscitation and quicker response to changes in patient's condition
- Use of vasoactive medications to help restore perfusion to vital organs
- Specific organ support when organs fail due to hypo perfusion
Invasive monitoring
- Central venous catheter
- Arterial line