Management of Shock. Scott Provost, MD University of Utah
|
|
|
- Ginger Randall
- 6 years ago
- Views:
Transcription
1 Management of Shock Scott Provost, MD University of Utah
2 Shock Serious, life-threatening medical condition where insufficient blood flow reaches the body tissues! Condition of severe impairment of tissue perfusion!
3 Shock Shock occurs at the cellular level! Cell dysoxia producing a measurable change in organ function! VO2 < MRO2 = SHOCK!
4 Treatment Identify cause of shock! Supportive measures! Treat underlying mechanism!
5 Etiology
6 Etiology Shock is caused by problems with! Pump (cardiogenic and noncardiogenic obstructive)! Tubing (distributive)! Fluid (hypovolemic)!
7 Etiology Cardiogenic Shock! Myopathic: acute MI, cardiomyopathy! Mechanical: valvular, papillary muscle! Arrhythmia!
8 Etiology Extracardiac Obstructive Shock! Pericardial tamponade! Massive pulmonary embolism! Tension pneumothorax!
9 Etiology Distributive Shock! Sepsis! Toxic! Anaphylaxis! Neurogenic! Endocrinologic!
10 Etiology Oligemic Shock! Hemorrhage! Volume depletion! Internal sequesteration!
11 Etiology Endocrine! Neurogenic! Drugs! Sepsis! Hypovolemic! Obstructive! Cardiac! END SHOC!
12 Clinical Manifestations
13 Clinical Manifestations Contingent of etiology! Typically manifest as:! Hypotension! Tachycardia! Weak pulses! Tachypnea! Oliguria (< 20 ml / hr)!
14 Eventual manifestations of anaerobic metabolism! Metabolic acidosis! Elevated lactate! Vasoactive substances!
15 Clinical Manifestaions Oligemic Shock! Flat jugular veins! Narrow pulse pressure! Cold, clammy extremities!
16 Clinical Manifestations Cardiogenic Shock! Evidence for CHF! Left heart failure: pulmonary crackles, SOB! Right heart failure: JVD, hepatic congestion, lower extremity edema! Murmur, irregular rhythm!
17 Clinical Manifestations Obstructive:! Similar to RHF symptoms/ signs! Unilateral chest rise/breath sounds with PTX! Muffled heart sounds, pulsus paradoxus with tamponade!
18 Clinical Manifestations Distributive Shock:! Warm extremities! Wheezing/ hives with anaphylaxis! Fever, chills with sepsis! Paralysis, spinal injury with spinal shock!
19 Hypovolemic Shock
20 Hypovolemic Shock Hemorrhage, GI losses, dehydration, burns! Loss of circulating blood volume! Decreased preload & cardiac output!
21 Compensation Mechanisms! Baroreceptors centrally mediated peripheral vasoconstriction! Autotransfusion! Renin-angiotensin-aldosterone!
22 Starling Curve:! End diastolic volume s influence on stroke volume!
23 Classification of Hemorrhage Class I: up to 15% of blood volume Normal pulse and blood pressure Class II: up to 30% of blood volume Tachycardia, decreased UOP, anxiety
24 Classification of Hemorrhage Class III: up to 40% blood volume Tachycardia, hypotension, tachypnea, oliguria, anxiety Class IV: > 40% blood volume marked tachycardia & hypotension, tachypnea, anuria, confusion, lethargy
25 Blood loss: most helpful sign/symtoms! Severe postural dizziness or postural pulse increment > 30 bpm! Vomiting/ diarrhea/ oral intake! Postural hypotension, sunken eyes, weakness, unclear speech!
26 Labs & Tests Hematocrit/ hemoglobin! Type & cross if hemorrhagic! BUN/creatinine ratio > 20! PA catheter:! CO, PCWP, SVR, CVP!
27 normal echo clip!
28 Treatment High flow oxygen! Adequate IV access! Restore blood or fluid loss! Goal: stabilize hemodynamics & maintain tissue perfusion!
29 Treatment High flow oxygen! Adequate IV access! Restore blood or fluid loss! Goal: stabilize hemodynamics & maintain oxygen delivery!
30 Insufficient evidence:! Early vs delayed resuscitation! Large vs small volume resuscitation! Hypertonic vs isotonic fluids!
31 Crystaloid vs Colloid Crystalloid Benefits:! May replace intravascular & interstitial fluid losses! Decreased blood viscosity may improve perfusion! Inexpensive!
32 Crystalloid Problems! Intravascular 1/2 life is minutes! Potential peripheral /pulmonary edema! Need for large quantities (3x blood loss)!
33 Colloid Benefits:! Longer intravascular 1/2 life (3-4 hours)! Less volume required (1x blood loss)! Potential for less peripheral edema!
34 Colloid Problems! Expensive! Leaky capillary membranes may worsen edema! Adverse effects!
35 Vs albumin:! anaphylactoid reactions more common with gelatin, hydroxymethyl starch and dextran (12x, 4x, 2x)! Pruritis, coagulopathy, bleeding more common with hydroxymethyl starch!
36 ICU patients: albumin vs saline! mortality, ICU stay, hospital stay, mechanical ventilation, new organ failure unchanged! albumin assoc with higher mortality in trauma pts, lower mortality in sepsis pts!
37 Crystalloids in sufficient amounts are as effective as colloids! Severe intravascular deficits are more rapidly corrected with colloids!
38 Consider colloid resuscitation! Severe intravascular deficit prior to arrival of blood for transfusion! Resuscitation in presence of protien losing conditions (burns)!
39 Cardiogenic Shock
40 Etiology Cardiac Output = SV * HR! Stroke volume:! failure to receive, failure to eject, inadequate volume! Heart rate:! too fast, too slow, ineffective!
41 Diagnosis History and physical! ECG! Pulmonary catheter! CO, PCWP, SVR, CVP! Echocardiography!
42 normal TG SAX!
43 poor ef!
44 Acute Coronary Syndrome ST segment myocardial infarction! Non ST segment myocardial infarction! Unstable Angina!
45 Risk Factors Coronary artery disease! Hypertension! Diabetes Mellitus! Tobacco! Family history!
46 Perioperative factors! Increased oxygen demand! Hypercoaguable state! Greatest risk of myocardial ischemia is 3rd postoperative day!
47 Pathogenisis Coronary artery plaque rupture! Thrombus formation! Decreased or absent coronary blood flow!
48 VO2 < MRO2!
49 Oxygen Supply/ Demand Mismatch VO2! Cardiac output! O2 content: (Hb*1.34*SpO2)! MRO2! HR! Afterload! Preload!
50 Detection History & Physical! ECG! ST changes! T wave inversion! New left bundle brach block! Arrythmia!
51 ECG slides!
52 Hypotension! Signs of heart failure! PA catheter: PCWP!
53 Management VO2 > MRO2!
54 Management Core principles! Optimize oxygenation, blood volume and hemoglobin! Minimize oxygen demand!
55 Management CO! Inotropes! Hb*1.34*SpO2! 100% oxygen! Red blood cells! VO2 > MRO2! Heart rate! Beta1 blocker! Calcium channel blocker! Afterload! Nitroprusside! beta2 blockers! anesthetic! Preload! Nitroglycerine!
56 Immediate interventions! 100% O2! Nitroglycerine IV! Aspirin! Morphine! Beta blockade: metoprolol, esmolol!
57 Antiplatelet therapy! Heparin! Weigh bleeding risk!
58 Reperfusion Therapy! Thrombolytics! Coronary Artery Bypass Graft! Percutaneous Intervention (stents)! Angioplasty!
59 Endocrine
60 Adrenal Crisis Suspect if! septic shock with N. meningitidis! recent glucocorticoid therapy! disseminated TB! AIDS! refractory hypotension!
61 Diagnosis Random serum cortisol! < mcg/dl: give cosyntropin (ACTH) stimulation test! Dexamethasone will not interfere with cosyntropin stim test!
62 Give Cosyntropin (ACTH) 250 ug IVP! Check post- ACTH! If cortisol inc by 7mcg/dl and absolute value >20mcg/dl! Secondary hypoadrenalism! Stop steroids!
63 If cortisol does not increase and is <20 mcg/dl! Primary hypoadrenalism! Stress dose steroids!
64 Treatment Dexamethasone 10 mg IV if diagnosis is unknown & planning stimulation test! Hydrocortisone 100 mg IV every 8 hours! d/c dexamethasone! Fluid resuscitation!
65 During illness or perioperative period, maintenance therapy must be increased! Hydrocortisone 50 mg IV every 8 hours! 1st dose preoperatively! Reduce to maintenance dose 3-4 days after surgery!
66 Anesthetic Implications
67 Anesthetic agents have direct cardiovascular depressant effects! Also inhibit compensatory hemodynamic mechanisms! Baroreflex (neuroregulatory)! Central catecholamine output!
68 IV anesthetics have less baroreceptor depression than inhalational agents! Thiopental, propofol, ketamine depress mechanism most (~ 10 minutes)! Opioids have minimal effect! Etomidate has little effect! Isoflurane < halothane!
69 Hemorrhage and hypovolemia! Higher blood concentrations of given dose! Preferential distribution of cardiac output to brain & heart! Increased sensitivity to some anesthetics! Cerebral hypoxia!
70 Pharmacokinetics/pharmacodynamic response of anesthetic agents is variable in shock models! Plasma concentrations & central clearance of fentanyl increased! Increased central /peripheral compartment concentration of etomidate! Propofol: higher concentration & increased brain sensitivity!
71
72 Ketamine! Stimulatory effects when autonomic nervous system is intact! Direct myocardial depressant!
73 Anesthesia in Hypovolemic Patients Important principles! Accurate estimation of degree of hypovolemia! Reduction of drug doses accordingly!
74 Propofol is a poor choice for patients in hemorrhagic shock! Significant cardiovascular effects, even with adequate fluid resuscitation! Etomidate has most stable hemodynamic platform in hemorrhagic shock!
75 Induction Time constraints/ continuing hemorrhage prevent restoration of blood volume! Airway must be secured with minimal or no anesthesia!
76 Maintenance All inhalational agents reduce regional and global blood flow! Isoflurane, desflurane, sevoflurane cause cardiovascular depression/ impair cardiac output in hypovolemia!
77 Nitrous oxide! Hypovolemia may unmask myocardial depressant property! Reduces FIO2! Pulmonary vasoconstriction!
78 Inhalational agents should be used only in small concentrations! < 1 MAC! Opioid supplementation usually well tolerated!
79 Bibliography Medline Plus, Shock, (April 2008)! Wikipedia, Shock (Medical), (April 2008)! Harrison s Principles of Internal Medicine: 14th Edition; Fauci; McGraw-Hill 1998! Clinical Anesthesia: Fifth Edition; Barash; Lippincott, Williams & Walker 2006! Colloids versus crystalloids for fluid resuscitation in critically ill patients. The Cochrane Database of Systematic Reviews 2004, Issue 4! Shafer SL: Shock Values. Anesthesiology 101:567, 2004! Johnson KB et al: The influence of hemorrhagic shock on propofol: A phamacokinetic and pharacodynamic analysis. Anesthesiology 99: !
SHOCK Susanna Hilda Hutajulu, MD, PhD
SHOCK Susanna Hilda Hutajulu, MD, PhD Div Hematology and Medical Oncology Department of Internal Medicine Universitas Gadjah Mada Yogyakarta Outline Definition Epidemiology Physiology Classes of Shock
SHOCK. Emergency pediatric PICU division Pediatric Department Medical Faculty, University of Sumatera Utara H. Adam Malik Hospital
SHOCK Emergency pediatric PICU division Pediatric Department Medical Faculty, University of Sumatera Utara H. Adam Malik Hospital 1 Definition Shock is an acute, complex state of circulatory dysfunction
12/1/2009. Chapter 19: Hemorrhage. Hemorrhage and Shock Occurs when there is a disruption or leak in the vascular system Internal hemorrhage
Chapter 19: Hemorrhage Hemorrhage and Shock Occurs when there is a disruption or leak in the vascular system External hemorrhage Internal hemorrhage Associated with higher morbidity and mortality than
-Cardiogenic: shock state resulting from impairment or failure of myocardium
Shock chapter Shock -Condition in which tissue perfusion is inadequate to deliver oxygen, nutrients to support vital organs, cellular function -Affects all body systems -Classic signs of early shock: Tachycardia,tachypnea,restlessness,anxiety,
Written 01/09/17 Rewritten 3/29/17 for Interior Regional EMS Symposium
Written 01/09/17 Rewritten 3/29/17 for Interior Regional EMS Symposium MARIA E. MANDICH MD Fairbanks Memorial Hospital Emergency Department Attending Physician Interior Region EMS Council Medical Director
Shock Quiz! By Clare Di Bona
Shock Quiz! By Clare Di Bona Test Question What is Mr Burns full legal name? Answer Charles Montgomery Plantagenet Schicklgruber Burns. (Season 22, episode 11) Question 1. What is the definition of shock?
SHOCK AETIOLOGY OF SHOCK (1) Inadequate circulating blood volume ) Loss of Autonomic control of the vasculature (3) Impaired cardiac function
SHOCK Shock is a condition in which the metabolic needs of the body are not met because of an inadequate cardiac output. If tissue perfusion can be restored in an expeditious fashion, cellular injury may
Case year old female nursing home resident with a hx CAD, PUD, recent hip fracture Transferred to ED with decreased mental status BP in ED 80/50
Case 1 65 year old female nursing home resident with a hx CAD, PUD, recent hip fracture Transferred to ED with decreased mental status BP in ED 80/50 Case 1 65 year old female nursing home resident with
Shock Management. Seyed Tayeb Moradian MSc, Critical Care Nursing Ph.D Candidate. PDF created with pdffactory Pro trial version
Shock Management Seyed Tayeb Moradian MSc, Critical Care Nursing Ph.D Candidate Definition of Shock The definition of shock does not involve low blood pressure, rapid pulse or cool clammy skin - these
Nothing to Disclose. Severe Pulmonary Hypertension
Severe Ronald Pearl, MD, PhD Professor and Chair Department of Anesthesiology Stanford University Rpearl@stanford.edu Nothing to Disclose 65 year old female Elective knee surgery NYHA Class 3 Aortic stenosis
Circulatory shock. Types, Etiology, Pathophysiology. Physiology of Circulation: The Vessels. 600,000 miles of vessels containing 5-6 liters of blood
Circulatory shock Types, Etiology, Pathophysiology Blagoi Marinov, MD, PhD Pathophysiology Dept. Physiology of Circulation: The Vessels 600,000 miles of vessels containing 5-6 liters of blood Vessel tone
Shock. Shao Mian Emergency Department,Zhongshan Hospital
Shock Shao Mian Emergency Department,Zhongshan Hospital What is shock THE BEGINNINGS OF UNDERSTANDING: THE LATE 19TH CENTURY THE AGE OF REASON: 1890 1925 THE MODERN ERA: BLALOCK S EPIPHANY POSTMODERNISM:
LeMone & Burke Ch 30-32
LeMone & Burke Ch 30-32 2 Right side- Low oxygenation Low pressure Light workload Goes toward the lungs Left side High oxygenation Thick walled high pressure Heavier workload Carries oxygenation blood
Physiological Response to Hypovolemic Shock Dr Khwaja Mohammed Amir MD Assistant Professor(Physiology) Objectives At the end of the session the
Physiological Response to Hypovolemic Shock Dr Khwaja Mohammed Amir MD Assistant Professor(Physiology) Objectives At the end of the session the students should be able to: List causes of shock including
CARDIOGENIC SHOCK. Antonio Pesenti. Università degli Studi di Milano Bicocca Azienda Ospedaliera San Gerardo Monza (MI)
CARDIOGENIC SHOCK Antonio Pesenti Università degli Studi di Milano Bicocca Azienda Ospedaliera San Gerardo Monza (MI) Primary myocardial dysfunction resulting in the inability of the heart to mantain an
SHOCK. Pathophysiology
SHOCK Dr. Ahmed Saleem FICMS TUCOM / 3rd Year / 2015 Shock is the most common and therefore the most important cause of death of surgical patients. Death may occur rapidly due to a profound state of shock,
Unit 4 Problems of Cardiac Output and Tissue Perfusion
Unit 4 Problems of Cardiac Output and Tissue Perfusion Lemone and Burke Ch 30-32 Objectives Review the anatomy and physiology of the cardiovascular system. Identify normal heart sounds and relate them
UPMC Critical Care
UPMC Critical Care www.ccm.pitt.edu Shock and Monitoring Samuel A. Tisherman, MD, FACS, FCCM Professor Departments of CCM and Surgery University of Pittsburgh Shock Anaerobic metabolism Lactic acidosis
Copyright 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Normal Cardiac Anatomy
Mosby,, an affiliate of Elsevier Normal Cardiac Anatomy Impaired cardiac pumping Results in vasoconstriction & fluid retention Characterized by ventricular dysfunction, reduced exercise tolerance, diminished
DEFINITION. Imbalance in supply/demand for O2 and nutrients
NURS 452 SHOCK Outcome Relate the pathophysiology to the clinical manifestations of the different types of shock: cardiogenic, hypovolemic, distributive, and obstructive Compare the collaborative care,
Case Scenario 3: Shock and Sepsis
Name: Molly Boyle 1. Define the term shock (Lewis textbook): Shock is a syndrome characterized by decreased perfusion and impaired metabolism. Shock can have a number of causes that result in damage to
How and why I give IV fluid Disclosures SCA Fluids and public health 4/1/15. Andrew Shaw MB FRCA FCCM FFICM
How and why I give IV fluid Andrew Shaw MB FRCA FCCM FFICM Professor and Chief Cardiothoracic Anesthesiology Vanderbilt University Medical Center 2015 Disclosures Consultant for Grifols manufacturer of
IV Fluids. I.V. Fluid Osmolarity Composition 0.9% NaCL (Normal Saline Solution, NSS) Uses/Clinical Considerations
IV Fluids When administering IV fluids, the type and amount of fluid may influence patient outcomes. Make sure to understand the differences between fluid products and their effects. Crystalloids Crystalloid
What would be the response of the sympathetic system to this patient s decrease in arterial pressure?
CASE 51 A 62-year-old man undergoes surgery to correct a herniated disc in his spine. The patient is thought to have an uncomplicated surgery until he complains of extreme abdominal distention and pain
SHOCK PATHOPHYSIOLOGY
SHOCK PATHOPHYSIOLOGY shock Shock is a condition in which the cardiovascular system fails to perfuse tissues adequately An impaired cardiac pump, circulatory system, and/or volume can lead to compromised
SHOCK. Voravit Chittithavorn. Cardiovascular Thoracic Surgery Department of Surgery
SHOCK Voravit Chittithavorn Cardiovascular Thoracic Surgery Department of Surgery Shock: Introduction Cellular Injury Multiorgans Dysfunction Irreversible Processing Unbalance Supply vs Demand Perfusion
Bachelor of Chinese Medicine Shock
BCM Year 2 Dr. Irene Ng Jan 28, 2003 9:30 am 1:00 pm Rm 004 UPB Bachelor of Chinese Medicine 2002 2003 Shock Learning objectives Be able to: know the definition of shock know the classification and causes
Cardiovascular Disorders Lecture 3 Coronar Artery Diseases
Cardiovascular Disorders Lecture 3 Coronar Artery Diseases By Prof. El Sayed Abdel Fattah Eid Lecturer of Internal Medicine Delta University Coronary Heart Diseases It is the leading cause of death in
Taking the shock factor out of shock
Taking the shock factor out of shock Julie Antonellis, BS, LVT, VTS (ECC) Northern Virginia Regional Director for the VALVT Technician Supervisor VCA Animal Emergency Critical Care Business owner Antonellis
PEDIATRIC SHOCK 10/9/2014. Objectives. What is shock? By the end of this presentation, the learner will be able to:
PEDIATRIC SHOCK Leanna R. Miller, RN, MN, CCRN-CMC, PCCN-CMS, CEN, CNRN, CPNP Education Specialist-LRM Consulting Nashville, TN Objectives By the end of this presentation, the learner will be able to:
Fluids in Sepsis: How much and what type? John Fowler, MD, FACEP Kent Hospital, İzmir Eisenhower Medical Center, USA American Hospital Dubai, UAE
Fluids in Sepsis: How much and what type? John Fowler, MD, FACEP Kent Hospital, İzmir Eisenhower Medical Center, USA American Hospital Dubai, UAE In critically ill patients: too little fluid Low preload,
Acute coronary syndromes
Acute coronary syndromes 1 Acute coronary syndromes Acute coronary syndromes results primarily from diminished myocardial blood flow secondary to an occlusive or partially occlusive coronary artery thrombus.
HYPOVOLEMIA AND HEMORRHAGE UPDATE ON VOLUME RESUSCITATION HEMORRHAGE AND HYPOVOLEMIA DISTRIBUTION OF BODY FLUIDS 11/7/2015
UPDATE ON VOLUME RESUSCITATION HYPOVOLEMIA AND HEMORRHAGE HUMAN CIRCULATORY SYSTEM OPERATES WITH A SMALL VOLUME AND A VERY EFFICIENT VOLUME RESPONSIVE PUMP. HOWEVER THIS PUMP FAILS QUICKLY WITH VOLUME
Tissue oxygenation is dependent upon, cardiac output, hemoglobin saturation and peripheral micro circulation.
Editorial Shock occurs when there is circulatory failure that results in inadequate cellular oxygen, that is arterial blood flow is inadequate to meet tissue metabolic needs. Tissue oxygenation is dependent
Agenda เอกราช อร ยะช ยพาณ ชย. - Cardiac physiology - Pathophysiology of shock - Pathophysiology of heart failure 9/6/2016
6 September 2016 เอกราช อร ยะช ยพาณ ชย Heart Failure and Transplant Cardiology aekarach.a@chula.ac.th Agenda - Cardiac physiology - Pathophysiology of shock - Pathophysiology of heart failure http://fullpulse.weebly.com/conversation
Means failure of heart to pump enough blood to satisfy the need of the body.
Means failure of heart to pump enough blood to satisfy the need of the body. Due to an impaired ability of the heart to adequately to fill or eject blood. HEART FAILURE Heart failure (HF) means decreased
Pediatric emergencies (SHOCK & COMA) Dr Mubarak Abdelrahman Assistant Professor Jazan University
Pediatric emergencies (SHOCK & COMA) Dr Mubarak Abdelrahman Assistant Professor Jazan University SHOCK Definition: Shock is a syndrome = inability to provide sufficient oxygenated blood to tissues. Oxygen
Post-Cardiac Surgery Evaluation
Post-Cardiac Surgery Evaluation 20th Annual Heart Conference October 15, 2016 Gary A Mayman PROFESSOR PEDIATRICS UNIVERSITY OF NEVADA Look Touch Listen Temperature, pulse, respiratory rate, & blood pressure
SHOCK. May 12, 2011 Body and Disease
SHOCK May 12, 2011 Body and Disease Shock Definition of shock Pathophysiology Types of shock Management of shock Shock Definition? Shock What the Duke Community would have experienced if Gordon Hayward
Cardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition
Cardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition Table of Contents Volume 1 Chapter 1: Cardiovascular Anatomy and Physiology Basic Cardiac
CCRN Review Cardiovascular
CCRN Review Cardiovascular Leanna R. Miller, RN, MN, CCRN-CMC, PCCN-CSC, CEN, CNRN, CMSRN, NP Education Specialist LRM Consulting Nashville, TN Angina Definition discomfort that occurs when oxygen demand
Cardiovascular Disorders. Heart Disorders. Diagnostic Tests for CV Function. Bio 375. Pathophysiology
Cardiovascular Disorders Bio 375 Pathophysiology Heart Disorders Heart disease is ranked as a major cause of death in the U.S. Common heart diseases include: Congenital heart defects Hypertensive heart
The Pharmacology of Hypotension: Vasopressor Choices for HIE patients. Keliana O Mara, PharmD August 4, 2018
The Pharmacology of Hypotension: Vasopressor Choices for HIE patients Keliana O Mara, PharmD August 4, 2018 Objectives Review the pathophysiology of hypotension in neonates Discuss the role of vasopressors
Irreversible shock can defined as last phase of shock where despite correcting the initial insult leading to shock and restoring circulation there is
R. Siebert Irreversible shock can defined as last phase of shock where despite correcting the initial insult leading to shock and restoring circulation there is a progressive decline in blood pressure
Presented by: Indah Dwi Pratiwi
Presented by: Indah Dwi Pratiwi Normal Fluid Requirements Resuscitation Fluids Goals of Resuscitation Maintain normal body temperature In most cases, elevate the feet and legs above the level of the heart
Results of Ischemic Heart Disease
Ischemic Heart Disease: Angina and Myocardial Infarction Ischemic heart disease; syndromes causing an imbalance between myocardial oxygen demand and supply (inadequate myocardial blood flow) related to
Physiology #14. Heart Failure & Circulatory Shock. Mohammad Ja far Tuesday 5/4/2016. Turquoise Team. Page 0 of 13
45 Physiology #14 Heart Failure & Circulatory Shock Mohammad Ja far Tuesday 5/4/2016 Turquoise Team Page 0 of 13 Heart Failure: It s a condition in which the heart can t perform its function properly;
Vasoactive Medications. Matthew J. Korobey Pharm.D., BCCCP Critical Care Clinical Specialist Mercy St. Louis
Vasoactive Medications Matthew J. Korobey Pharm.D., BCCCP Critical Care Clinical Specialist Mercy St. Louis Objectives List components of physiology involved in blood pressure Review terminology related
Hypotension / Shock. Adult Medical Section Protocols. Protocol 30
Hypotension / Shock History Blood loss - vaginal or gastrointestinal bleeding, AAA, ectopic Fluid loss - vomiting, diarrhea, fever nfection Cardiac ischemia (M, CHF) Medications Allergic reaction regnancy
How Normal Body Processes Are Altered By Disease and Injury
1 Chapter 4, GENERAL PRINCIPLES OF PATHOPHYSIOLOGY. Part 1 How Normal Body Processes Are Altered By Disease and Injury 2 How Cells Respond to Change and Injury 3 Pathology & Pathophysiology : the study
Division 1 Introduction to Advanced Prehospital Care
Division 1 Introduction to Advanced Prehospital Care Topics Fluids & fluid imbalances IV Therapy Hypoperfusion Shock Fluids and Fluid Imbalances 1 Water is the most abundant substance in the human body.
Shock and hemodynamic monitorization. Nilüfer Yalındağ Öztürk Marmara University Pendik Research and Training Hospital
Shock and hemodynamic monitorization Nilüfer Yalındağ Öztürk Marmara University Pendik Research and Training Hospital Shock Leading cause of morbidity and mortality Worldwide: dehydration and hypovolemic
Cardiology. Objectives. Chapter
1:44 M age 1121 Chapter Cardiology Objectives art 1: Cardiovascular natomy and hysiology, ECG Monitoring, and Dysrhythmia nalysis (begins on p. 1127) fter reading art 1 of this chapter, you should be able
เอกราช อร ยะช ยพาณ ชย
25 September 2017 เอกราช อร ยะช ยพาณ ชย Heart Failure and Transplant Cardiology aekarach.a@chula.ac.th Presentation at 1 Agenda Physiology of the heart Pathophysiology of shock Pathophysiology of heart
SHOCK and the Trauma Victim. JP Pretorius Department of Surgery & SICU Steve Biko Academic Hospital.
SHOCK and the Trauma Victim JP Pretorius Department of Surgery & SICU Steve Biko Academic Hospital. Classification of Shock Cardiogenic - Myopathic Arrythmic Mechanical Hypovolaemic - Haemorrhagic Non-haemorrhagic
Heart disease remains the leading cause of morbidity and mortality in industrialized nations. It accounts for nearly 40% of all deaths in the United
Heart disease remains the leading cause of morbidity and mortality in industrialized nations. It accounts for nearly 40% of all deaths in the United States, totaling about 750,000 individuals annually
Impedance Cardiography (ICG) Application of ICG in Intensive Care and Emergency
Impedance Cardiography (ICG) Application of ICG in Intensive Care and Emergency Aim of haemodynamic monitoring in ICU and ED Detection and therapy of insufficient organ perfusion Answers to common cardiovascular
Case I: Shock. A) What additional history would you like from the nursing home staff, patient s chart, and ambulance team?
Case I: Shock It is your first night of call during your subinternship month, and you are asked by your resident to evaluate a patient in the emergency room. The patient is a 85yo female with a history
Emergency Medical Training Services Emergency Medical Technician Paramedic Program Outlines Outline Topic: Shock Revised: 11/2013
Emergency Medical Training Services Emergency Medical Technician Paramedic Program Outlines Outline Topic: Shock Revised: 11/2013 (12 questions on trauma exam from this outline) DEFINITIONS Aerobic metabolism
Introduction to Emergency Medical Care 1
Introduction to Emergency Medical Care 1 OBJECTIVES 6.1 Define key terms introduced in this chapter. Slides 11, 15, 17, 26, 27, 31, 33, 37, 40 42, 44, 45, 51, 58 6.2 Describe the basic roles and structures
Department of Intensive Care Medicine UNDERSTANDING CIRCULATORY FAILURE IN SEPSIS
Department of Intensive Care Medicine UNDERSTANDING CIRCULATORY FAILURE IN SEPSIS UNDERSTANDING CIRCULATORY FAILURE IN SEPSIS a mismatch between tissue perfusion and metabolic demands the heart, the vasculature
Hypovolemic Shock: Regulation of Blood Pressure
CARDIOVASCULAR PHYSIOLOGY 81 Case 15 Hypovolemic Shock: Regulation of Blood Pressure Mavis Byrne is a 78-year-old widow who was brought to the emergency room one evening by her sister. Early in the day,
Echocardiography as a diagnostic and management tool in medical emergencies
Echocardiography as a diagnostic and management tool in medical emergencies Frank van der Heusen MD Department of Anesthesia and perioperative Care UCSF Medical Center Objective of this presentation Indications
Medical APMLE. Podiatry and Medical.
Medical APMLE Podiatry and Medical http://killexams.com/exam-detail/apmle Question: 290 Signs and symptoms of hemolytic transfusion reactions include: A. Hypothermia B. Hypertension C. Polyuria D. Abnormal
Objectives. Objectives. Shock. Objectives. Cardiac output. Review of Blood Flow and Perfusion. Review the components of perfusion
Objectives Shock Review the components of perfusion Cardiac output Perfusion at the capillary level Perfusion and cellular metabolism Aerobic metabolism and energy production Objectives Identify the stages
Introduction (1 of 3)
Chapter 10 Shock Introduction (1 of 3) Shock (hypoperfusion) means a state of collapse and failure of the cardiovascular system. In the early stages, the body attempts to maintain homeostasis. As shock
How Normal Body Processes Are Altered By Disease and Injury
1 Chapter 4, General Principles of Pathophysiology Part 1 How Normal Body Processes Are Altered By Disease and Injury 2 How Cells Respond to Change and Injury 3 Pathology & Pathophysiology : the study
Disclosures. Objectives 10/11/17. Short Term Mechanical Circulatory Support for Advanced Cardiogenic Shock. I have no disclosures to report
Short Term Mechanical Circulatory Support for Advanced Cardiogenic Shock Christopher K. Gordon MSN, ACNP-BC Disclosures I have no disclosures to report 1. Pathophysiology 2. Epidemiology 3. Assessment
Evidence-Based. Management of Severe Sepsis. What is the BP Target?
Evidence-Based Management of Severe Sepsis Michael A. Gropper, MD, PhD Professor and Vice Chair of Anesthesia Director, Critical Care Medicine Chair, Quality Improvment University of California San Francisco
CrackCast Episode 6 Shock
CrackCast Episode 6 Shock Episode overview: 1) List, define and explain the 5 causes of shock 2) What is the utility of lactate and base deficit in the management of shock? 3) Define: SIRS, Sepsis, Severe
Pediatric Code Blue. Goals of Resuscitation. Focus Conference November Ensure organ perfusion
Pediatric Code Blue Focus Conference November 2015 Duane C. Williams, MD Pediatric Critical Care Department of Pediatrics Children s Hospital of Richmond at VCU Goals of Resuscitation Ensure organ perfusion
Ruminations about the Past, Present, and Future
Ruminations about the Past, Present, and Future Raymond L. Fowler, MD, FACEP, DABEMS Professor and Chief Division of Emergency Medical Services Department of Emergency Medicine UT Southwestern Medical
PALS Pulseless Arrest Algorithm.
PALS Pulseless Arrest Algorithm. Kleinman M E et al. Circulation 2010;122:S876-S908 PALS Bradycardia Algorithm. Kleinman M E et al. Circulation 2010;122:S876-S908 PALS Tachycardia Algorithm. Kleinman M
Nursing Process Focus: Patients Receiving Dextran 40 (Gentran 40)
Assess for presence/history of hypovolemia, shock, venous thrombosis. Assess vital signs: Hypovolemic shock secondary to surgery, burns, hemorrhage, other serious condition PT and PTT abnormalities Venous
Utilizing Vasopressors:
Utilizing Vasopressors: Critical Care Advances in the Emergency Department José A. Rubero, MD, FACEP, FAAEM Associate Program Director University of Central Florida/HCA GME Consortium Emergency Medicine
Congestive Heart Failure Patient Profile. Patient Identity - Mr. Douglas - 72 year old man - No drugs, smokes, moderate social alcohol consumption
Congestive Heart Failure Patient Profile Patient Identity - Mr. Douglas - 72 year old man - No drugs, smokes, moderate social alcohol consumption Chief Complaint - SOB - When asked: Increasing difficulty
Prehospital Care Bundles
Prehospital s The MLREMS Prehospital s have been created to provide a simple framework to help EMS providers identify the most critical elements when caring for a patient. These bundles do not replace
Useful diagnostic measures: chest x ray to check pulmonary edema, ECG and ECHO to detect cardiac abnormalities (1).
Cardiogenic shock Etiology The most common cause of cardiogenic shock is LV dysfunction and necrosis as a result of acute myocardial infarction (AMI) (1). Acute valvular insufficiency or stenosis prevents
DAY1_CARDIOVASCULAR PRACTICE QUESTIONS
DAY1_CARDIOVASCULAR PRACTICE QUESTIONS 1 P age 1. A 59-year-old male is admitted complaining of chest pain and dyspnea. ST elevation and T-wave inversion were seen on the ECG in V2, V3, and V4. IV thrombolytic
Review of Cardiac Mechanics & Pharmacology 10/23/2016. Brent Dunworth, CRNA, MSN, MBA 1. Learning Objectives
Brent Dunworth, CRNA, MSN, MBA Associate Director of Advanced Practice Division Chief, Nurse Anesthesia Vanderbilt University Medical Center Nashville, Tennessee Learning Objectives Review the principles
10/16/2014. CCRN Review - Cardiovascular. CCRN Review - Cardiovascular. CCRN Review - Cardiovascular
Hypertrophic (IHSS) Diagnosis Chest x ray cardiomegaly Electrocardiography LV hypertrophy, ST segment T was changes, Q waves in inferior & precordial leads Atrial & ventricular dysrhythmias Hypertrophic
Printed copies of this document may not be up to date, obtain the most recent version from
Children s Acute Transport Service Clinical Guidelines Septic Shock Document Control Information Author Claire Fraser P.Ramnarayan Author Position tanp CATS Consultant Document Owner E. Polke Document
1 Chapter 10 Shock 2 Shock Shock: Inadequate State of collapse and failure of the system Leads to inadequate circulation Without adequate blood flow,
1 Chapter 10 Shock 2 Shock Shock: Inadequate State of collapse and failure of the system Leads to inadequate circulation Without adequate blood flow, cannot get rid of metabolic wastes Results in hypoperfusion
IV fluid administration in sepsis. Dr David Inwald Consultant in PICU St Mary s Hospital, London CATS, London
IV fluid administration in sepsis Dr David Inwald Consultant in PICU St Mary s Hospital, London CATS, London The talk What is septic shock? What are the recommendations? What is the evidence? Do we follow
Cardiogenic Shock. Carlos Cafri,, MD
Cardiogenic Shock Carlos Cafri,, MD SHOCK= Inadequate Tissue Mechanisms: Perfusion Inadequate oxygen delivery Release of inflammatory mediators Further microvascular changes, compromised blood flow and
More History. Organization. Maternal Cardiac Disease: a historical perspective. The Parturient with Cardiac Disease 9/21/2012
The Parturient with Cardiac Disease Pamela Flood M.D. Professor of Anesthesia and Perioperative Care Obstetrics, Gynecology and Reproductive Sciences University of California, San Francisco Maternal Cardiac
Anesthesia for Cardiac Patients for Non Cardiac Surgery. Kimberly Westra DNP, MSN, CRNA
Anesthesia for Cardiac Patients for Non Cardiac Surgery Kimberly Westra DNP, MSN, CRNA Anesthesia for Cardiac Patients for Non Cardiac Surgery Heart Disease is a significant problem in the United States:
Shock. William Schecter, MD
Shock William Schecter, MD The Cell as a furnace O 2 1 mole Glucose Cell C0 2 ATP 38 moles H 2 0 Shock = Inadequate Delivery of 02 and Glucose to the Cell 0 2 Cell ATP 2 moles Lactic Acid Treatment of
We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to
Author(s): Patrick Carter, Daniel Wachter, Rockefeller Oteng, Carl Seger, 2009-2010. License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution
Pre-discussion questions
Amanda Bartlett, PA-C Dustin Bartlett, PA-C Andrea Applegate, PA-C Leslie Yearta Brown, NP CHF Round Table Discussion Objectives ANDREA- Discuss the definition and different categories of CHF DUSTIN- Define
9/11/2012. Chapter 11. Learning Objectives. Learning Objectives. Endocrine Emergencies. Differentiate type 1 and type 2 diabetes
Chapter 11 Endocrine Emergencies Learning Objectives Differentiate type 1 and type 2 diabetes Explain roles of glucagon, glycogen, and glucose in hypoglycemia Learning Objectives Discuss following medications
The Septic Patient. Dr Arunraj Navaratnarajah. Renal SpR Imperial College NHS Healthcare Trust
The Septic Patient Dr Arunraj Navaratnarajah Renal SpR Imperial College NHS Healthcare Trust Objectives of this session Define SIRS / sepsis / severe sepsis / septic shock Early recognition of Sepsis The
Fluids and electrolytes: the basics
Fluids and electrolytes: the basics This document is based on the handout from the Surgery for Finals course. The notes provided here summarise key aspects, focusing on areas that are popular in clinical
Algorithm Focus. Emergency Cardiovascular Care: EMT-Intermediate Treatment Algorithms. Perspective regarding the EMT- Intermediate algorithms
Emergency Cardiovascular Care: EMT-Intermediate Treatment Algorithms Algorithms for the Conscious Patient Prehospital Medication Profiles Algorithm Focus Bradycardia Acute Pulmonary Edema and Shock Hypothermia
Hemodynamic Disorders Thrombosis and Shock. 1. Interstitial, between the cells, but outside of the vascular system. - water making up the blood and
Hemodynamic Disorders Thrombosis and Shock I. Body water, where is it and what keeps it there? A. Intracellular B. Extracellular (intercellular) 1. Interstitial, between the cells, but outside of the vascular
Categories & Complications
Shock, Fluid & Therapy Arthur Jones, EdD, RRT Learning Objectives: Explain the etiologies, manifestations and management of shock. Describe specific agents used to maintain blood pressure, fluid balance
SHOCK. can contribute to one of the four kinds of shock. Sometimes the cause of shock is multi-factorial.
SHOCK GENERAL CONSIDERATIONS A. Hypoperfusion (shock) is the inadequate delivery of vital oxygen and nutrients to body tissues, which left unchecked will result in organ system failure and death. B. No
Pediatric Shock. National Pediatric Nighttime Curriculum Written by Julia M. Gabhart, M.D. Lucile Packard Children s Hospital at Stanford
Pediatric Shock National Pediatric Nighttime Curriculum Written by Julia M. Gabhart, M.D. Lucile Packard Children s Hospital at Stanford Pre-Topic Questions 1. Why is it important to identify the stage
Lecture 8 Cardiovascular Health Lecture 8 1. Introduction 2. Cardiovascular Health 3. Stroke 4. Contributing Factors
Lecture 8 Cardiovascular Health 1 Lecture 8 1. Introduction 2. Cardiovascular Health 3. Stroke 4. Contributing Factors 1 Human Health: What s Killing Us? Health in America Health is the U.S Average life
1/3/2008. Karen Burke Priscilla LeMone Elaine Mohn-Brown. Medical-Surgical Nursing Care, 2e Karen Burke, Priscilla LeMone, and Elaine Mohn-Brown
Medical-Surgical Nursing Care Second Edition Karen Burke Priscilla LeMone Elaine Mohn-Brown Chapter 26 Caring for Clients with Coronary Heart Disease and Dysrhythmias Coronary Heart Disease (CHD) Leading