Cardiogenic shock is a profound circulatory disturbance characterized by failure to maintain adequate organ perfusion. It can be intracardiac or extracardiac in origin. Types of shock include cardiogenic, hypovolemic, and distributive such as sepsis. Diagnosis involves assessing response to fluids, echocardiogram, chest x-ray, and evidence of infection. A Swan-Ganz catheter can help differentiate types of shock but its use remains controversial. Management focuses on correcting the underlying cause, maintaining blood pressure and oxygen levels, and providing vasopressors or inotropes depending on the shock type.
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Cardiogenic shock is a profound circulatory disturbance characterized by failure to maintain adequate organ perfusion. It can be intracardiac or extracardiac in origin. Types of shock include cardiogenic, hypovolemic, and distributive such as sepsis. Diagnosis involves assessing response to fluids, echocardiogram, chest x-ray, and evidence of infection. A Swan-Ganz catheter can help differentiate types of shock but its use remains controversial. Management focuses on correcting the underlying cause, maintaining blood pressure and oxygen levels, and providing vasopressors or inotropes depending on the shock type.
Cardiogenic shock is a profound circulatory disturbance characterized by failure to maintain adequate organ perfusion. It can be intracardiac or extracardiac in origin. Types of shock include cardiogenic, hypovolemic, and distributive such as sepsis. Diagnosis involves assessing response to fluids, echocardiogram, chest x-ray, and evidence of infection. A Swan-Ganz catheter can help differentiate types of shock but its use remains controversial. Management focuses on correcting the underlying cause, maintaining blood pressure and oxygen levels, and providing vasopressors or inotropes depending on the shock type.
Copyright:
Attribution Non-Commercial (BY-NC)
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Download as PPT, PDF, TXT or read online from Scribd
Cardiogenic shock is a profound circulatory disturbance characterized by failure to maintain adequate organ perfusion. It can be intracardiac or extracardiac in origin. Types of shock include cardiogenic, hypovolemic, and distributive such as sepsis. Diagnosis involves assessing response to fluids, echocardiogram, chest x-ray, and evidence of infection. A Swan-Ganz catheter can help differentiate types of shock but its use remains controversial. Management focuses on correcting the underlying cause, maintaining blood pressure and oxygen levels, and providing vasopressors or inotropes depending on the shock type.
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SHOCK
DEFINITION Profound hemodyamic and metabolic disturbance characterized by failure of the circulatory system to maintain adequate perfusion of vital organs
Types of Shock Cardiogenic (intracardiac vs extracardiac) Hypovolemic Distributive sepsis**** neurogenic (spinal shock) adrenal insufficiency anaphylaxis
Cardiogenic Shock, intracardiac
Myocardial Injury or Obstruction to Flow Arrythymias valvular lesions AMI Severe CHF VSD Hypertrophic Cardiomyopathy
Hypotensive flat neck veins clear lungs cool, cyanotic extremities evidence of bleeding? Anticoagulant use trauma, bruising
oliguria
Distributive Shock Peripheral Vasodilation secondary to disruption of cellular metabolism by the effects of inflammatory mediators. Gram negative or other overwhelming infection. Results in decreased Peripheral Vascular Resistance.
Diagnosing Shock Response to fluids Echo/EKG CXR Evidence of infection Swan-Ganz Catheter?
Swan-Ganz Catheter Utilized to differentiate types of shock and assist in treatment response. Probably overused by physicians. Studies documenting increased mortality in patients with catheters versus no catheters, although somewhat swayed by selection bias.
Management Correct underlying disorder if possible and then direct efforts at increasing the blood pressure to increase oxygen delivery to the tissues. Maintain a mean arterial pressure of 60 (1/3 systolic + 2/3 diastolic) Keep O2 sats >92%, intubate if neccesary
Correction of hypotension Normal Saline should be administered anytime a patient is hypotensive. If hypotension exists give more NS. *** If possible give blood as it replaces colloid. Vasopressors Inotropic agents for cardiogenic shock Intra-aortic Balloon Pump for cardiogenic
Attempt to correct problem and increase cardiac output by diuresing and providing inotropic support. IABP is utilized if medical therapy is ineffective. Catheterization if ongoing ischemia Cardiogenic shock is the exception to the rule that NS is always given for hypotension NS will exacerbate cardiac shock.
Intra-Aortic Balloon Pump
Management of Septic Shock
Early goal directed therapy Identification of source of infection Broad Spectrum Antibiotics IV fluids Vasopressors Steroids ?? Recombinant human activated protein C ( Xygris) Bicarbonate if pH < 7.1
Management of Hypovolemic Shock
Correct bleeding abnormality If PT or PTT elevated then FFP Aggressive Fluid replacement with 2 large bore IVs or central line. Pressors are last line, but commonly required.
Addisons Disease Deficiency of cortisol and aldosterone production in the adrenal glands This is suspected when patient is nonresponsive to fluids and antibiotics. Electrolytes may reveal hyponatremia and hyperkalemia Hydrocortisone 100 mg IV immediately then taper appropriately
Knowledge, Attitude and Practices About Prevention of Transmission Hepatitis B Virus Among Nursing Students On Ward Placement at KIU Teaching Hospital.
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