刘保池《急诊医学精品教学》3-休克课件1.pdfVIP

SHOCK Once someone were sent into ICU, it may be a real Farewell. In the ICU n  Shock is affecting about 30% patients in the ICU who were assigned to receive either dopamine or norepinephrine n  septic shock occurred in 62% n  cardiogenic shock in 16% n  hypovolemic shock in 16% n  distributive shock in 4% n  obstructive shock in 2%. What is “SHOCK” ? n  n  Shock is defined as acute circulatory failure, a situation in which the circulation fails to provide cells with sufficient oxygen to be able to perform optimally. Introduction n  Diagnosis of shock is based on: n  Shock can broadly be summarized into three components: n  Systemic arterial hypotension in adults: n  the SBP90mmHg n  the MAP70mmHg, with associated tachycardia. n  Tissue hypoperfusion-the three “windows” of the body: n  cutaneous (skin that is cold and clammy) n  renal (urine output of0.5ml/kg/h) n  neurologic (altered mental state includes obtundation, disorientation, and confusion). n  Hyperlactatemia n  the level 1.5mmol/l in acute circulatory failure. Historical Story n  The word ‘shock’--French surgeon Henri LeDran; ‘choc’ in the English translation--”Shock”; n  In 1827 English surgeon, George Guthrie first used the word “shock” in association with a physiological response to injury n  Dr. Thomas Latta in 1831- intravenous fluids for Hypovolemia n  the key early contributor was Dr. Max Harry Weil n  Died of prostate cancer July 29,2011 at his home. n  “He believed very strongly that we should be able to save more lives, thats what he was working his whole life to do. Classification of Shock The four pathophysiological