(精选)【医学课件大全】SHOCK (43p)教学课件.pptVIP

SHOCK;Western record violent impact or blow, 1743 physiologic instability, 1815 Eastern record 厥脱，内闭外脱;Initial Explanation of shock;with the Rise of Physiology;with the Combination of  Physiology and Biochemistry;Antedate the Era of Critical Care Medicine;Controversy on Lung Kidney;A syndrome that results from inadequate perfusion of tissues insufficient to meet metabolic demand lead to cellular dysfunction, elaboration of inflammatory mediators, and celluar injury which may be limited, or widespread A continuum, ranging from subclinical deficits in perfusion to MODS or frank organ failure. Tissue hypoxia due to hypoperfusion Defects Injury;O2 Debt Whether DO2crit is increased in ARDS, or sepsis ? Delivery -dependent oxygen uptake = Hypoxia cause MODS supranormal levels supply of O2 prevent the progression of MODS ? Providing opportunity for intervention Providing time for the disease to subsider ;Circulatory redistribution;intrinsic obstruction of cap. Bed low-flow states, hypothermia, and increased viscosity cap. Sludging: intravascular coagulation, platelet aggregation, other intraluminal debris preventing RBC from reaching the tissues extrinsic obstruction of cap. Bed local tissue inflammation, edema, or hemorrhage, ACS vessel wall permeability deficit;Hypovolemic Shock Hemorrhage - Plasma losses - Cardiogenic Shock Intrinsic - Extrinsic Compressive - Obstructive -;Neurogenic Shock e.g. Vasogenic Shock SIRS, toxin Septic despite adequate fluid resucitation Traumatic Anaphylactic and Anaphylactoid Hypoadrenal;The others There may be a “ ” to be filled. but “cellular shock”, such as poisoning, hypoxia, hypoglycemia, is not the syndrome, continuum, or tissue hypoxia due to hypoperfusion, may be excluded from the category of shock.;各型休克的共同特点是：;Secondary visceral impairement; Microcirculatory Staging;后微A; Metabolic Changes; Secondary Visceral Impairment;Clinical Staging;Shock inhibiting stage faint, dullness, confusion, coma cyanosi