What is “SHOCK” ?
n ջ‫ظ‬ฎ೰‫ݱ‬ᐿܻࢩ୚᩸ํප஗ሾᤅᰁ‫ٺ‬੝̵ᕟᕢᅆ ဳӧ᪃̵ᕡᙱդᨀᔯԤ޾‫ۑ‬ᚆ‫ݑ‬ഖጱየቘኞቘᬦᑕ̶
ҁӾ܏‫܅‬਍տ᯿ዩ‫܅‬਍‫ړ‬տ೰‫ܖ‬҂
n Shock is defined as acute circulatory failure, a situation in which the circulation fails to provide cells with sufficient oxygen to be able to perform optimally.
Farewell.
In the ICU
n Shock is affecting about 30% patients in the ICU who were assigned to receive either dopamine or norepinephrine
n septic shock occurred in 62% n cardiogenic shock in 16% n hypovolemic shock in 16% n distributive shock in 4% n obstructive shock in 2%.
Obstructive Distributive
Hemorrhage҅Trauma Dehydration
Myocardial infarction Cardiomyopathy Valvular disease
Severe arrhythmias Pulmonary embolism
Tamponade Aortic dissection Inflammatory response (mediators)
n Tissue hypoperfusion-the three “windows” of the body:
n cutaneous (skin that is cold and clammy) n renal (urine output of<0.5ml/kg/h) n neurologic (altered mental state includes obtundation, disorientation, and
n the key early contributor was Dr. Max Harry Weil
n Died of prostate cancer July 29,2011 at his home. n “He believed very strongly that we should be able to save more lives, that's what he
SHOCK
My Heart Will Go On
3
Young Men vs. Middle-aged Gentleman
James Roy Horner (14th, Aug, 1953҆22nd, Jun, 2015)
5
Once someone were sent into ICU, it may be a real
Severe arrhythmias Pulmonary embolism
Tamponade Aortic dissection Inflammatory response
(mediators)
Distributive Shock
Vasodilation
Cardiogenic Shock
Ventricular failure
Hypovolemic Shock
Loss of plasma or blood volume
Obstructive Shock
Obstruction
Pericardial tamponade
Pathophysiological type Hypovolemic Cardiogenic
Obstructive
Distributive
Cause
Hemorrhage҅Trauma Dehydration
Myocardial infarction Cardiomyopathy Valvular disease
n In 1827 English surgeon, George Guthrie first used the word “shock” in association with a physiological response to injury
n Dr. Thomas Latta in 1831- intravenous fluids for Hypovolemia
was working his whole life to do."
Classification of Shock
The four pathophysiological types of shock & principal causes
Pathophysiologicovolemic Cardiogenic
confusion).
n Hyperlactatemia
n the level >1.5mmol/l in acute circulatory failure.
Historical Story
n The word ‘shock’--French surgeon Henri LeDran; ‘choc’ in the English translation--”Shock”; ܾዩ
Introduction
n Diagnosis of shock is based on:
n Shock can broadly be summarized into three components:
n Systemic arterial hypotension in adults:
n the SBP<90mmHg n the MAP<70mmHg, with associated tachycardia.