SHOCK

⚡️⚡️SHOCK ⚡️⚡️

Definition:

Hypoperfusion of an organ

Signs:

• BP Systolic<90mmHg, Diastolic<60mmHg
• Tachycardia
• Skin changes

BP=CO✖️PR

CO=SV✖️HR

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Types of Shock:

Hypovolumic Shock: Blood Loss, Vomiting, Diarrhea, Dehydration

Diagnosis is on History, CVP<8, Chest Auscultation

Rx:

• 1L Blood loss is replaced with 1L of colloid or 3L of crytalloid.
• In Hypovolumic shock 2-3L of fluid can be given.
• After 2-3L, fluid can be given according to UOP, CVP & Chest Auscultation.
• Norepinephrine >>> alpha & Beta

Cardiogenic Shock: MI, Ischemia, Valvular Heart Disease,

Diagnose on ECG changes

Rx:

• fluid 200-300ml

Inotropic Support:

• Dopamine & Dobutamine

Acts,

• At low dose on Dopa receptors
• At medium dose on Dopa & Beta receptors
• At high dose on Dopa, Beta & Alpha receptors

Obstructive Shock: Physical Obstruction around Heart. e.g. Myocarditis, Endocarditis, Pericardial Effusion.

Rx: Relieve the cause.

Neurogenic/Vasovagal Shock: Stress, Trauma

Rx: Leg Elevation>>> "Bradycardia"

Anaphylactic Shock:

Reaction>> Mediators>> Vasodilation & Bronchoconstrition

Rx: 

• Norepinephrine acts at;
  • Alpha: inc. Peripheral Resistance
  • Beta: inc. Heart Rate
• Phenyephrine acts at;
  • Alpha: inc. Peripheral Resistance

Septic Shock: 

Bacteria>> Exotoxins>> Mediators>> Vasodilation

• Skin will be warm only in Septic shock.

Rx: 

• Norepinephrine acts at;
  • Alpha: inc. Peripheral Resistance
  • Beta: inc. Heart Rate
• Phenyephrine acts at;
  • Alpha: inc. Peripheral Resistance
• Inj. Rocephin 1g for gram -ve