9. Obstructive shock. Etiology and pathogenesis. Pulmonary embolism.

Cardiac
tamponade. Clinical picture. Diagnosis and treatment.

- Obstructive Shock occurs when the normal flow of blood is obstructed.

- Several conditions result in this form of shock:

o Cardiac tamponade - Blood in the pericardium prevents blood from entering the
heart (venous return).

o Pneumothorax - Increased pressure within the thoracic cavity blocks the normal
flow of blood to the heart.

o Pulmonary embolism - The result of a blockage (embolus) in the blood vessels of

the lungs, blocking the return of blood to the heart.

PULMONARY EMBOLISM - embolism (usually a blood clot from the pelvic veins or deep
veins of the legs) that becomes lodged in the pulmonary artery in the chest – 10% of those
embolisms result in death.

Clinical consequences of a pulmonary embolism:

- Sudden death, acute right heart failure

- Pulmonary infarction
- Pulmonary hypertension, chronic right heart failure, pulmonary vascular sclerosis

Cardiac Tamponade - If fluid creates sufficient pressure to cause cardiac compression = serious
condition tamponade.

- Danger of tamponade is that pressure exerted by pericardial fluid eventually equals

diastolic pressure within heart chambers.

- First structures to be affected by tamponade are right atrium & ventricle because diastolic
pressures are normally lowest therein.

- Subsequent decreased atrial filling leads to decreased ventricular filling, decreased stroke
volume, and reduced cardiac output.

- Life-threatening circulatory collapse may develop.

- Most significant clinical finding in tamponade is pulsus paradoxus -> arterial blood
pressure during expiration exceeds arterial pressure during inspiration by more than
10mm Hg -> impairment of diastolic filling of left ventricle, plus reduction of blood
volume within all cardiac chambers.

Treatment - aspiration of excessive pericardial fluid.

- Persistent pain is treated with analgesics, anti-inflammatory agents, or steroids.

- Surgery may be required if the tamponade cause is trauma or aneurysm.