英文休克医学课件.ppt

A. 心功能不全 B. 血容量不足 C. 血容量过多 D. 血管张力升高 E. 以上都不是 休克病人经补液后，血压仍低。5 ~ 10 min内经静脉注入等渗盐水250ml，如血压上升，而中心静脉压不变，提示： Shock MODS Disturbance Death ? Timing Strategy ! ! ! Effort Effect ii. Current Strategy for Shock Solution Prevention, early Identification, early and specific treatment for Shock and MODS 感染 创伤 烧伤 SAP SIRS 代谢 紊乱低氧 乏氧代谢 休克 复苏失败 痊愈 MODS 好转 MODS 第 二 次 打 击 心源性、神经源性因素 低血容量 血 管 源 性 Primary Secondary （感染） (24h) 死亡 1. Hypovolemic shock Symptom a decrease in pulse pressure tachycarida and hypotension urine output falls normal skin turgor is lost mental status changes - in a progressive fashion apprehension, anxiety, complete obtundation CVP decrease Treatment Resuscitation Control the inciting cause of shock Specific 2. Traumatic shock Type Vasogenic shock that begins as hypovolemic shock Character - refractory to fluid replacement therapy Larger volume losses, greater fluid sequestration More intense activation of inflammatory mediators Development of SIRS Devastating soft tissue injuries Machanism increasing microvascular permeability, Excessive fluid requirement Frequently Require mechanical ventilation, Pulmonary artery catheter monitoring Cardiovascular support Operation Specific 3. Septic shock Type Vasogenic shock, Refractory to fluid replacement therapy Definition Sepsis with hypotension despite adequate fluid resuscitation along with the presence of manifestations of hypoperfution such as lactic acidosis, obliguria, or acute alteration in mental status Mechanism Cytokines Vasodilatation, Increasing microvascular permeability, Excessive fluid requirement Specific Treatment of Septic shock Resuscitation Control infection Normalization of electrolytes, acid base dearangement Inotropic agent Corticosteroids Nutritional support, deal with DIC, organ function support Specific 4. Anaphylactic  and Anaphylactoid shock Mechanism Inflammatory mediators C3a, C5a, Histamine, Kinnins, Prostaglandins symptoms Vasodilatation,