Betsy Franco Alva

CIRCULATORY SHOCK

Shock is the clinical expression of circulatory failure

that results in inadequate cellular oxygen utilization.

Diagnosis

• CLINICAL
• HEMODYNAMIC
• BIOCHEMICAL
 THREE COMPONENTS.

Systemic arterial hypotension

• Systolic arterial pressure is less than 90 mm hg

• Mean arterial pressure is less than 70 mm Hg, tachycardia.

Hypoperfusion

• Cutaneous (skin that is cold and clammy, with vasoconstriction and cyanosis)
• Renal (urine output of <0.5 ml kg hour)
• Neurologic (altered mental state, obtundation, disorientation, and confusion).

Hyperlactatemia abnormal cellular oxygen metabolism. (>1.5

mmol per liter)
 Pathophysiological Mechanisms
Hypovolemia • from internal or external fluid loss
Low
cardiac
output
Cardiogenic • acute myocardial infarction, end-stage
cardiomyopathy, advanced valvular heart and, hence,
factors disease, myocarditis, or cardiac arrhythmias inadequate
oxygen
transport.
• pulmonary embolism, cardiac tamponade,
Obstruction or tension pneumothorax

The main deficit

Distributive • severe sepsis or anaphylaxis from the lies in the
periphery, with
release of inflammatory mediators
factors decreased systemic
vascular resistance
and altered oxygen
extraction.
 DIFFERENTIAL DIAGNOSIS

Septic shock, a form of distributive

shock, is the most common

Cardiogenic shock or distributive

shock may also occur, alone or in
combination

Skin color and temperature, jugular

venous distention, and peripheral
edema. Echocardiographic evaluation
DIFFERENTIAL DIAGNOSIS
DIFFERENTIAL DIAGNOSIS
INITIAL APPROACH TO THE PATIENT IN
SHOCK
VIP rule:
Ventilate (oxygen
administration)
Ventilatory Support

Infuse (fluid resuscitation)

Fluid Resuscitation
Pump (administration of
vasoactive agents).
Vasoactive Agents
• Vasopressors
• Inotropic Agents
• Vasodilators
GOALS OF HEMODYNAMIC SUPPORT

Arterial Pressure
PAM 65 a
70 mm Hg.

Cardiac Output
and Oxygen GC - SvO 2
Delivery

Blood Lactate
Level <20% 2 H

Microcirculatory
Variables
THERAPEUTIC PRIORITIES AND GOALS
 CONCLUSIONS

Circulatory shock is associated with high morbidity and mortality.

Prompt identification

Treatment Aggressive
• Correction of the cause
• Hemodynamic stabilization
• Fluid infusion and administration of vasoactive agents.
Monitored
• Careful clinical evaluation
• Blood lactate measurements