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Shock syndrome


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What are the consequences of shock
death or multiple organ dysfunction
Clinical presentation of shock
SBP <90 or MAP <65
Tachy >90
Tachypnea RR >20
altered mental status
decreased organ perfusion decreased urine output
metabolic acidosis
Hemodynamics of Hypovolemic shock
decrease PCWP
decrease CO
increase SVR
Hemodynamics of cardiogenic shock
decease CO
increase PCWP
increase SVR
Hemodynamics of septic shock
decrease SVR
increase CO
decrease PCWP
What is hypovolemic shock and etiologies
-internal bleeding
--aortic aneurysm
--gi bleed
--retroperitoneal bleed
-fluid loss burns,heat stroke
Goals of hypovolemic shock
PCWP 10-12
CVP 15
CI 3 L/min
What is cardiogenic shock
sustained hypotension and reduced CI leads to inadequate tissure perfusion due to cardiac dysfuction
Causes of cardiogenic shock
acute Mitral regurg
rupture of interventricular septum
acute MI
end-stage cardiomyopathy
myocardial contusion
septic shock with sever myocardial depression
valvular heart dz
hypertrophic obstructive cardiomyopathy
Goals of management of cardiogenic shock
CI >2.5
PCWP <18
MAP >65
Uout >0.5 ml/kg/hr
Rationale of inotropes in cardiogenic shock
increase contracility increase HR and CO
peripheral vasodilation
rationale of vasopressors in cardiogenic shock
increase MAP
rationale of diuretics in cardiogenic shock
decrease PCWP
rationale of vasodilators in cardiogenic shock
decrease SVR but last line
Mechanical options for cardiogenic shock
intra-aortic balloon pump
ventricular assist device
bi-vent assist device
primary etiology of responsible of vasodilatory shock also called septic
acute adrenal insuffciency
what is sepsis
SIRS with presence of infection
what is severe sepsis
sepsis with organ dysfunction defined my MODS of SOFA
What is septic shock
sepsis with hypotension despite adequate volume resus. SBP <90 of MAP <60
What qualilfies as systemic inflammatory response syndrome (SIRS)
core temp >38.3 <36
HR >90
RR >20 or PaO2 <32
WBC >12,000 or <4000 or >10% bands

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