surgical procedures and management

Apr 15th, 2015
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SHOCKShock -definition An imbalance between oxygen demand andsupplyOR systemic reduction in tissue perfusion, resultingin decreased tissue oxygenation and insufficientremoval of cellular metabolic products, resultingin tissue injury.Classification of Shock Hypovolemic- decreased preloadDistributive-decrease in systemic vascular resistanceSepticNeurogenic Cardiogenic- pump failureOutcome of untreated shockTraumaBurnsMicrobial invasionAcute pancreatitisinsultMaldistributionHypermetabolismOf circulating fluidinflammatory responsemultiple organ dysfunctionDeathHypovolemic shockFluid loss resulting in inadequate circulatingvolume and subsequently inadequateperfusionCauseshemorrhage(internal or external)extensive burnsrefractory gastroenteritisthird space loss e.g. Pancreatitis, intestinalobstructionClinical featuresLow BP(unreliable)Tachycardia(caution-- -blockers)Low volume pulseCold clummy skinMental state changesOliguriaelevated shock index (heart rate/systolic bloodpressure > 0.9) Redistribution of blood to the brain, heart, andkidneys and away from skin, muscle, and GI tract.Classes of hemorrhageClass I hemorrhage (loss of 0-15%) minimal tachycardia . BP, pulse pressure, and respiratory rate are normal. A delay in capillary refill of longer than 3 secondsClass II hemorrhage (loss of 15-30%) tachycardia (rate >1

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