Basic derangement is inadequate CO with compensatory vasoconstriction n tissue hypoperfusion

a] Hypovolemic shock
@ hemorhage, severe vomiting n  diarhea, burns, acute pancreatitis , diabetic ketoacidosis

b] Cardiogenic
@ acute MI( >40% of myocardium damaged), acute AR, MR myocarditis, dilated cardiomyopathy

c] Septic
@ Gram +ve n -ve bact

d] Anaphylactic
e] Neurogenic
@ high cervical cord injury, severe head inj.

a] sympathoadrenal n neuroendocrine response
@ hypotension stimulates baro n chemoreceptors leads 2 increased sympathetic activity
@ hypoperfusion of kidney   release renin in turn angiotensin
@ during shock increased ADH n cortisol release retaining fluid n sodium
b] Inflammatory reaction
@ more apparent in septic shock
@ endotoxin by Gm-ve bact  stimulate release of cytokine(TNF, IL1, IL10), PAF,PG n LT, activation of complement components

@ systolic BP <100 mm Hg
@ tachycardia (>100/min)
@ cold clammy skin
@ tachypnea  Cheyne Stoke breathing
@urine output <30 ml/ hr

A] patient monitoring
@ monitor pulse BP n RR n ECG 4 HR rhythm
@ ABG n pH analysis 4 correction of acidosis n hypoxia
@ central venour pressure monitor
@ pulm capillary wedge press with Swan Ganz catheter
@ urinary n arterial catheterisation

B] General Measures
@ care of airway bowel n bladder n nutrition
@ relieve pain n anxiety
@ correction hypovolemia
- by blood, RL, isotonic NS , dextran, albumin, plasma,
@ Prevention n treatment of renal complications
- after correction of hypovolemia
- diuresis by furosemide or mannitol
- IV Low dose dopamine vasodilator of renal vessels
@ correction of hypoxia by O2 by face mask or intubate
@ correction of acidosis by IV sod bicarbonate
@ Rx of cardiac arrhythmia with drugs electrical cardioversion
@ Rx of sepsis by Antibiotic

C] Sympathomimetic Amines
only used after correcting vol deficit
@  act by increasing CO selective vasoconstriction
@ raise BP n redistribute blood flow 2 vital organs but away 4m skin n skeletal muscle
@Aim is elevation of systolic  BP betn 110- 120 mm Hg n maintain urinary output >30 ml/hr
@ Drugs
- dopamine: 3 or 10 or >10 micro gm /kg/min
- dobutamine: 1-10 micro gm/kg/min
- noradrenaline: 2-8 micro gm/kg/min
- adrenaline: 1-8micro gm/kg/min
- isoproterenol: 1-4 micro gm/min
- phenylephrine: 20-200 microgm/min

# Cardiogenic
@ dobutamine n dopamine r used
@ venodilators nitroglycerine n nitroprusside
@ circulatory assist devices
-intra aortic balloon counterpulsation
- extracorporeal membrane oxygenator (ECMO)
@ surgery 4 ruptured papillary muscle,acute MR, rupture of IV septum, MI

# septic
@ large vol of iv fluid
@ Antibiotics
@ surgical drainage of abscess
@ corticosteroids in moderate doses may be needed

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