SHOCK

SHOCK by: CRISBERT I. CUALTEROS, MD

Types of Shock According to Etiology: ,[object Object],[object Object],[object Object]

Hypovolemic Shock ,[object Object],[object Object],[object Object],[object Object],[object Object]

Cardiogenic Shock ,[object Object],[object Object]

Distributive Shock ,[object Object],[object Object],[object Object],[object Object],[object Object]

Types of Shock According to Its Effect on Blood Pressure: ,[object Object],[object Object]

Signs of Shock: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

P5 Systolic Blood Pressure for Age ,[object Object],[object Object],[object Object],[object Object],[object Object]

Septic Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Clinical Diagnosis of Septic Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Objectives of Fluid Resuscitation: ,[object Object],[object Object],[object Object]

Types of Fluids: ,[object Object],[object Object],[object Object]

Crystalloids ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Crystalloids ,[object Object],[object Object],[object Object],[object Object]

Colloids ,[object Object],[object Object],[object Object],[object Object],[object Object]

Blood Products ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Blood Products ,[object Object],[object Object],[object Object],[object Object]

Fluid Bolus Administration ,[object Object],[object Object]

Fluid Bolus Administration ,[object Object]

Drugs That Support Cardiac Output ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],Drugs That Support Cardiac Output

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Drugs That Support Cardiac Output

Dopamine ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],Dopamine

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Dopamine

Dobutamine ,[object Object],[object Object],[object Object]

Dobutamine ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Dobutamine

Epinephrine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],Epinephrine

Norepinephrine ,[object Object],[object Object],[object Object],[object Object],[object Object]

Norepinephrine ,[object Object],[object Object],[object Object],[object Object]

Sodium Nitroprusside ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],Sodium Nitroprusside

Milrinone ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],Milrinone

Postarrest shock Fluid bolus (10-20 ml/kg NS or RL, monitor response) Reassess – signs of shock continue What is blood pressure ? Hypotensive (decompensated) shock? Normotensive (compensated) shock? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Approach to Selection of Vasoactive Medications for Postresuscitation Hemodynamic Stabilization

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Fluid responsive ? ,[object Object],[object Object],[object Object],[object Object],Proposed Algorithm for Treatment of Septic Shock Yes No ,[object Object],[object Object],[object Object],Catecholamine-resistant shock Is patient at risk for adrenal insufficiency? 0-5 min 15 min Carcillo JA, Fields AI: Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock. Crit Care Med 2002; 30: 1365-1378

[object Object],Normal blood pressure, cold shock, SVC O 2 sat <70% Proposed Algorithm for Treatment of Septic Shock Yes No ,[object Object],[object Object],[object Object],Catecholamine-resistant shock Is patient at risk for adrenal insufficiency? ,[object Object],[object Object],Patient is stable Patient is unstable Patient is unstable Low blood pressure, cold shock, SVC O 2 sat <70% Low blood pressure, warm shock ,[object Object],[object Object],[object Object],[object Object],60 min Carcillo JA, Fields AI: Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock. Crit Care Med 2002; 30: 1365-1378

[object Object],[object Object],[object Object],[object Object],[object Object],Proposed Algorithm for Treatment of Septic Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Patient is stable Patient is unstable Carcillo JA, Fields AI: Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock. Crit Care Med 2002; 30: 1365-1378

SHOCK

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SHOCK