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Shock
Definition: Inadequate oxygen delivery and utilisation by vital organs due to a problem with the circulation.
Types of shock
Usually can be recognized by the observations and peripheral circulation Classic obs are Tachycardic (>90bpm), Hypotensive (<90-100mmHg),
Others
Classic peripheral circulation would be delayed capillary refill and cool peripheries
0.9%salineat least 1000ml. Usually significantly more than this. When concerned re CCF, can try 500ml bolus at first (or 250ml if very concerned) Observe response
Consider
urinary catheter (further monitoring and obtain sample) Placement : monitoring, resus
Hypovolaemic
Distributive
Sepsis
Sepsis = 2 or more SIRS criteria + suspected or proven infection (1992) SIRS Temperature >38C or <36C Heart rate > 90 beats/min Respiratory rate > 20 breaths/min or PaCO2 <32 torr (<4.3kPa) WBC > 12.000 cells/mm3, <4.000 cells/mm3, or >10% immature (band)forms
Distributive Management
Distributive Sepsis : IV antibiotics, iv fluids, IV inotropes (ARISE trial) Anaphylaxis : IM adrenaline, iv fluids, steroids, antihistamines
Cardiogenic
Cardiogenic Management
Cardiogenic (iv fluid) Tachyarrythmia : DC/chemical cardioversion Bradyarrythmia : Atropine, pacing Pump problem : Inotropes PCI
Obstructive
Obstructive PE : heparin, fibrinolytic Tension pneumothorax : Needle decompression Pericardial effusion : Pericardiocentesis
0.9%salineat least 1000ml. Usually significantly more than this. When concern re CCF, can try 500ml bolus at first (or 250ml if very concerned) Observe response
Consider
urinary catheter (further monitoring and obtain sample) Placement : monitoring, resus
But
Bewareyoung people Elderly Pregnant Those on beta blockers