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Shock in Adults and Childrenmultiple organ failure

http://www.nlm.nih.gov/medlineplus/ency/imagepages/17231.htm

http://www.nlm.nih.gov/medlineplus/ency/imagepages/19150.htm

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Shock

A condition in which the cardiovascular system fails to perfuse the tissues adequately

This failure causes general and widespread impairment of cellular metabolism

Many factors cause shock Defective heart function, blood

volume changes, or blood vessel changes

http://images.google.co.nz/imgres?imgurl=

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Shock Shock can be classified by cause,

pathophysiologic process, or clinical manifestations Cardiogenic (caused by heart failure) Neurogenic or vasogenic (alterations in

smooth muscle tone) Anaphylactic (hypersensitivity) Septic (caused by infection) Hypovolemic (insufficient intravascular

fluid) Traumatic (components of hypovolemic

and septic)

http://www.aic.cuhk.edu.hk/web8/Hi%20res/man%20with%20shock.jpg

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Shock

Patient complaints Weak, “feeling sick,” cold, hot,

nauseated, dizzy, confused, afraid, thirsty, short of breath

Blood pressure, cardiac output, and urinary output are usually decreased; the respiratory rate is usually increased

Treatment is to correct or remove the underlying cause and provide supportive therapy

http://grunt.space.swri.edu/images/vn/billm/sickbaby.jpg

http://www.chiroweb.com/find/images/sick_man.gif

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Shock Impairment of cellular metabolism

Impairment of oxygen use Aerobic to anaerobic metabolism Lose ability to maintain an

electrochemical gradient Sodium and chloride accumulate in

the cell• Water follows, thus reducing the

extracellular volume Potassium exits the cell Activated positive feedback loops

• Coagulation pathway activation, decreased circulatory volume, lysosomal enzyme release

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Shock

Impairment of cellular metabolism Impairment of glucose use

Impaired glucose delivery or impaired glucose uptake

Cells shift to glycogenolysis, gluconeogenesis, and lipolysis

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Shock

Cardiogenic Heart failure Caused by myocardial ischemia,

MI, CHF, myocardial or pericardial infections, dysrhythmias, and drug toxicity

Hypovolemic Insufficient intravascular fluid

volume Loss of whole blood, blood

plasma, interstitial fluid, or fluid sequestration

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Cardiogenic Shock

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Hypovolemic Shock

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Shock Neurogenic (vasogenic)

Widespread vasodilation from an imbalance between parasympathetic and sympathetic simulation

Causes persistent vasodilation and creates relative hypovolemia

Severe pain and stress, anesthesia, and depressant drugs

Anaphylactic Immune alterations Widespread hypersensitivity reaction

leading to vasodilation, peripheral pooling, and relative hypovolemia

More severe due to other pathophysiologic effects

http://images.google.co.nz/images?svnum=10&hl=en&q=shock+-+children

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Neurogenic Shock

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Anaphylactic Shock

http://www.nlm.nih.gov/medlineplus/ency/imagepages/19320.htm

http://www.marine.ie/NR/rdonlyres/00CF50B0-B063-401A-AF23-5F982244FE92/0/LionManecropped.jpg

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Shock

Septic Infectious processes initiate septic

shock Bacteremia, endotoxins, and

exotoxins cause the host to initiate the inflammatory process Complement, coagulation, kinin,

and cellular immunity The inflammatory response

initiates and promotes widespread vasodilation

Demonstrates symptoms similar to neurogenic and anaphylactic shock

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Evaluation of Shock

Arterial blood gas (ABG) Serum lactate concentration Blood pressure Ventilation and oxygenation Chemistry analytes

Electrolytes, glucose, BUN, liver function, calcium, phosphorus, cardiac enzymes

Hemoglobin and hematocrit

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Treatment of Shock

Adequate oxygen delivery Monitor body temperature Transfusion of blood components IV fluids (volume resuscitation) Monitor urine output and specific

gravity Monitor blood pressure

http://images.google.co.nz/images?q=shock+-+medical&ndsp=18&svnum=10&hl=en&start=72&sa=N

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Emerging Therapies for Shock and Sepsis Injury prevention Haemophilus influenzae and

Neisseria meningitidis vaccines Colony-stimulating factors to

increase white blood counts in immunocompromised individuals

Infectious disease control Resuscitation techniques

http://www.samc.com/UMAP/UserImages/Pharmacist_IV.jpg

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Multiple Organ Dysfunction Syndrome Progressive dysfunction of two or more

organ systems due to an uncontrolled inflammatory response to a severe illness or injury

Shock and sepsis are the most common causes, but any injury or disease that initiates massive systemic inflammation can cause multiple organ dysfunction Trauma, major surgery, burns, acute

pancreatitis, acute renal failure, ARDS, etc.

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Multiple Organ Dysfunction Syndrome 54% mortality rate if two organ systems are

affected Mortality rate increases to 100% with five

systems failing

http://www.tpub.com/content/medical/14295/css/14295_161.htm

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Multiple Organ Dysfunction Syndrome Maldistribution of blood flow Hypermetabolism Myocardial depression Supply-dependent oxygen consumption Reperfusion injury

http://www.gcra.org.uk/images/Heart.jpg

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Burns

A common result of inadequate supervision, curiosity, inability to escape the burning agent, or intentional abuse

Child abuse 6% to 20% of child burn injuries

are child abuse Pattern burns, forced emersion

burns, splash/spill burns, cigarette burns

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Severity of Injury Total body surface area (TBSA) Standard rule of nines is inaccurate in

children Arms and trunk demonstrate same

proportions as an adult Head and neck—18% Each lower extremity—14%

Depth of injury Age Areas of the body burned Secondary injuries and manifestations

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