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4.shock & Monitoring
4.shock & Monitoring
4.shock & Monitoring
www.gims-org.com
Shock
Shock is a Cardiovascular Derangement.
1. Deliver Oxygen and Metabolic Substrates
2. Remove Products of Cellular Metabolism
3. Thermoregulation
Definition:
A physiological state characterized by a significant,
systemic reduction in tissue perfusion, resulting in
decreased tissue oxygen delivery and insufficient
removal of cellular metabolic products, resulting in
tissue injury.
Classification of Shock
•Hypovolemic
•Septic/Inflammatory
•Cardiogenic (Intrinsic, compressive &
Obstructive)
•Neurogenic
•Anaphylactic
Clinical Markers of Shock
•Brachial systolic blood pressure: <110mmHg
•Sinus tachycardia: >90 beats/min
•Respiratory rate: <7 or >29 breaths/min
•Urine Output: <0.5cc/kg/hr
•Metabolic acidemia: [HCO3]<31mEq/L or base deficit>3mEq/L
•Hypoxemia: 0-50yr: <90mmHg; 51-70yr:
K <80mmHg;
>71yo<70mmHg; l
k
•Cutaneous vasoconstriction vs. vasodilation.
j
afterload distributive
Etiology & Hemodynamic Changes
in Shock (Afterload)
ETIOLOGY EXAMPLE CVP CO SVR VO2 SAT
OF SHOCK
AFTERLOAD DISTRIBUTIVE
Causes:
1. Spinal cord injury
2. Regional anesthesia
3. Drugs
4. Neurological disorders
Neurogenic Shock
• Characterized by loss of vascular tone & reflexes.
• Sphyngomanometry
• Pulse Oximeter
• Arterial Line
K
l
k
j
Pulmonary Artery
Catheterization: cardiovascular
performance
Central Venous Pressure (CVP):
CVP = right atrial pressure (RAP) = right-ventricular
end-diastolic pressure (RVEDP) (Right Ventricular
Preload)
K
Pulmonary Capillary Wedge Pressure (PCWP)
l
PCWP = left atrial pressure (LAP) k=
left-ventricular
j
end-diastolic pressure (LVEDP) (Left Ventricular
Preload)
Cardiovascular Performance
Cardiac Output (CO) = HR x SV (L/min)
Normal CO = 4 to 8 L/min