休克与处理技术.pdf

休克與處理技術 張國頌 醫師 醫務專員 SHOCK SYNDROME Shock is a condition in which the cardiovascular system fails to perfuse tissues adequately An impaired cardiac pump, circulatory system, and/or volume can lead to compromised blood flow to tissues Inadequate tissue perfusion can result in: generalized cellular hypoxia (starvation) widespread impairment of cellular metabolism tissue damage organ failure death PATHOPHYSIOLOGY Impaired tissue perfusion occurs when an imbalance develops between cellular oxygen supply and cellular oxygen demand All Types of shock eventually result in impaired tissue perfusion the development of acute circulatory failure or shock syndrome PATHOPHYSIOLOGY Cells switch from aerobic to anaerobic metabolism lactic acid production Cell function ceases swells membrane becomes more permeable electrolytes fluids seep in out of cell Na+/K+ pump impaired mitochondria damage cell death COMPENSATORY MECHANISMS Sympathetic Nervous System -Adrenal Response Neuro-hormonal response stimulated by baroreceptors Increased heart rate Increased contractility Vasoconstriction (SVR-afterload) Increased preload COMPENSATORY MECHANISMS Sympathetic Nervous System-Adrenal Response Hormonal: Antidiuretic Hormone Osmoreceptors in hypothalamus stimulated ADH released by Posterior pituitary gland Vasopressor effect to increase BP Acts on renal tubules to retain water COMPENSATORY MECHANISMS Sympathetic Nervous System -Adrenal Response Hormonal: Adrenal Cortex Anterior pituitary releases adreno- corticotropic hormone (ACTH)