PRECIOUS IKHIANOSE AITANUN  ·  CLINICAL JOURNAL
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Trauma Care – Shock Overview

Daily Serious

Detailed mindmap on shock

CLASS DIAGRAM

presents with
treated by
Shock
+Acute circulatory failure
+Cellular dysfunction
+Life-threatening
+evaluatePatient()
+restoreTissuePerfusion()
HypovolaemicShock
+Collapse of cardiac preload
+Blood / Plasma / ECF loss
+controlBloodLoss()
+replaceFluid()
CardiogenicShock
+Pump failure
+MI / Arrhythmias / Cardiomyopathy
+improveContractility()
DistributiveShock
+Collapse of peripheral resistance
+Vasodilation / pooling
+restoreVascularTone()
ObstructiveShock
+Restricted blood outflow
+PE / Tamponade / Pneumothorax
+removeObstruction()
EndocrineShock
+Mixed presentation
+Hormonal imbalance
+correctHormones()
SepticShock
+Bacterial endotoxins
+Cytokine activation
+administerAntibiotics()
AnaphylacticShock
+Type 1 hypersensitivity
+Histamine release
+administerAdrenaline()
NeurogenicShock
+Unopposed vagal tone
+Spinal cord injury
+administerVasopressors()
ClinicalFeatures
+Cold skin / Rapid pulse
+Type-dependent signs
+Oliguria / CNS disturbance
Management
+O2 / IV access / Monitor
+Type-specific therapy
+Prevent DIC / MODS

FLOW CHART

SHOCK
Acute circulatory failure compromising tissue perfusion
Introduction
Types of Shock
Clinical Features
INVESTIGATIONS
Management
Definition: Acute circulatory failure
compromising tissue perfusion
Manifestation of cellular
dysfunction due to inadequate perfusion
Life-threatening: progresses to
irreversible damage if untreated
Hypovolaemic Shock
Cardiogenic Shock
Distributive Shock
Obstructive Shock
Endocrine Shock
Definition: Collapse of cardiac
preload due to reduced volume
Causes
Pathophysiology
Blood Loss
Internal hemorrhage
External hemorrhage
Loss of Plasma
Extensive burns
Peritonitis
Loss of Extracellular Fluid
Intestinal obstruction
Diarrhea and vomiting
Massive fluid loss into
interstitial tissues
Sepsis
Acute pancreatitis
Early Stage
Reduced circulating volume
Baroreceptor response
Adrenal-sympathetic stimulation
Adrenaline/Noradrenaline release
Increased heart rate and vasoconstriction
Middle Stage
Continued sympathetic overactivity
Activation of RAAS
Splanchnic vasoconstriction
Bacterial translocation
Anaerobic respiration and lactic acidosis
Late Stage
Compensatory mechanisms fail
Capillary endothelium damage
Decreased cerebral blood flow
Progressive cerebral dysfunction
Definition: Pump failure;
ventricles fail to pump sufficiently
Causes
Acute Myocardial Infarction
Arrhythmias
Cardiomyopathies
Heart valve problems
Mechanical factors
Definition: Collapse of
peripheral resistance
Mechanisms
Subtypes
Vasodilation of arterioles & venules
Peripheral pooling
Septic Shock
Bacterial endotoxins
Cytokine activation
Endothelial damage
Anaphylactic Shock
Type 1 hypersensitivity reaction
Histamine/vasoactive amine release
Neurogenic Shock
Unopposed vagal tone
Cervical spinal cord injury
Definition: Physical restriction
to blood outflow
Causes
Pulmonary embolism
Cardiac tamponade
Tension pneumothorax
Combination of hypovolaemic,
cardiogenic, and distributive shock
Causes: Hormonal imbalances
General Features
Cold, white, clammy patient
Rapid thready pulse
Increased respiratory rate
Fall in arterial BP
Reduced urinary output
Septic Shock contrast
Hot, flushed skin
Bounding pulse
Severe Signs
Weak, thready pulse
Cold, clammy skin
Collapsed peripheral veins
Rapid respiration
CNS disturbances
Oliguria or anuria
Baseline hemoglobin/hematocrit
Blood grouping and cross-matching
Serum electrolytes, urea, creatinine
Arterial blood gases
Serum lactate
Blood glucose
Blood cultures
Aim: Restore tissue perfusion and oxygenation
General Steps
Specific Treatment
Complications
Oxygen therapy
Venous access and fluid resuscitation
Continuous assessment
Treat primary problem
Hypovolaemic Shock Treatment
Identify cause of fluid loss
Control blood loss
Fluid replacement
Cardiogenic Shock Treatment
Cautious fluid resuscitation
Improve myocardial contractility
Treat underlying pathology
Anaphylactic Shock Treatment
Adrenaline
Hydrocortisone & Chlorpheniramine
IV fluids
Neurogenic Shock Treatment
Secure airway
Fluid resuscitation
Vasoconstrictors if needed
Septic Shock Treatment
Adequate fluid resuscitation
Appropriate antibiotics
Surgical elimination of infection source
Disseminated Intravascular Coagulation
Multiple Organ Dysfunction Syndrome
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