春8.SHOCK-LECTURE.ppt

SHOCK Shen Hong Zhejiang University School of Medicine. Historical Aspects The concept of shock has evolved over the centuries from the earliest description in antiquity of traumatic wounds and hemorrhage. Hippocratic facies (460~380 B.C.): tourniguet. Bloodletting Galen (A.D. 130~200): erroneous knowledge of anatomy. Ligation of bleeding vessels Vesalius. William Harvey (16 centuries): anatomy and circulation of the cardiovascular system A French military surgeon: the use of simple bandages Thomas Latta: in 1831. infusion of intravenous fluids into hypo-volemic patients inflicted with cholera caused clinical improvent. Pathogenesis: a. vasomotor exhaustion: neurogenic theory b. traumatic toxemia: cannon. Bay(World War I) c. hypovolemia: Keith, Blalock(experiments on dogs) d. fat embolism; e. acidosis f. adrenal dysfunction Pathogenesis: resuscitation, individual argan dysfunction, cellular derangements(Korean, Vietnam conflict). Shock lung. ARDS molecular biology, inflammatory mediator, metabolic support, oxygen delivery, organ ischemia, sepsis. II. Definition of shock A syndrome results from inadequate perfusion of tissues alterations in cellular metabolism, cellular dysfunction and cellular injury, MODS due to tissue hyperfusion, hypoxia. Oxygen delivery; oxygen debt; oxygen demand exceeds the oxygen supply. III. Cause, classification of shock 1. hypovolemic shock 1) hemorrhagic losses: trauma, gastrointestinal bleeding ruptured aneurysm. 2) plasma volume losses: extravascular fluid sequestration, pancreatitis, burns, bowel obstruction. 2. cardiogenic shock dinminished cardiac output intrinsic cause extrinsic cause myocardial infarction cardiac rhythm disturbances. Tension pneumothorax pericardial tamponade 3. neurogenic shock failure of the sympathetic nervous system to maintain normal vascular tone. Spinal cord injury, severe head injury. Spinal anesthesia 4. vasogenic endogenous or exogenous vaso-active mediators systemic inflammatory