(精选)Shock教学课件.ppt

All secondary to body’s attempt to compensate and increase cardiac output and maintain perfusion to vital organs (brain heart kidneys). Tachycardia alone (secondary to drecreased stroke volume) usually first sign. Increased endogenous catecholamines cause vasoconstriction causing delayed cap refill. Skin can also be warm and dry. As compensatory mechanisms cannot meet demands uncompensated shock ensues.. see signs related to tissue ischemia and release of mediators affecting microcircluation Rales, gallop, enlarged liver, jugular venous distension Severe shock should be considered first…sometimes need vasodilator such as sodium nitroprusside…..0.3mcg/kg or higher leads to more alpha stim..lower dose decrease systemic vascular resistance higher doses ncrease it Next choice is epi RL – ca can react w/ meds and potassium w/ no urine but might work better in acidodic state Prospective, randomized, 57 patients not in shock receiving bolus 20 cc/kg to test 5 min ACCM guidelines Which medication(s) should be given immediately? Albuterol Epinephrine Benadryl All of the above Which medication(s) should be given immediately? Albuterol Epinephrine Benadryl All of the above Anaphylactic Shock Epinephrine (1:1000) 0.01 mg/kg IM Q15 min Max dose: 0.3 mg 0.1 -1 mcg/kg/min IV (1:10,000) 0.01 mg/kg IV/IO (hypotension) Albuterol PRN H1 blocker H2 blocker Corticosteroids Solumedrol 2 mg/kg/dose Case 10 yo male present s/p pedestrian struck. The accident was unwitnessed. The patient is unconscious. His vitals are: T 35 C HR 65 BP 80/40 RR 22 Neuro – unable to elicit reflexes in LE You are concerned this patient is in what type of shock? Cardiogenic Neurogenic Hypovolemic Septic You are concerned this patient is in what type of shock? Cardiogenic Neurogenic Hypovolemic Septic Neurogenic Shock Hypotension / bradycardia / hypothermia Patient flat or trendelenberg Fluids Vasopressors Epinephrine Norepinephrine Warming or cooling Steroids Case A 1 yo female p/w lethargy and i