| ID | 230 |
|---|---|
| Name | SHOCK |
| Cause | |
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| Diagnosis | |
| Investigations | |
| Management | Management: 1. Maintenance of vital function. a. Maintenance of respiration, 02 inhalation. b. Raising foot end to increase cerebral circulation. 2. Restoration of blood volume and pressure- by fluid/plasma/blood. 3. Prevention of renal failure- - keeping urine output above 50ml/hour. - diuretics may be needed. 4. Improving myocardial contractility by dopamine or adrenaline. 5. Correction of acidosis (by 7.5% NaHCO3) 6. Hydrocortisone 200 mg i.v stat & then lOOmg when needed. Treatment of underlying cause- 1. Vasovagal shock- is quickly combated by laying the patient flat and raising the legs. 2. Hemorrhagic shock- is treated by-i. Stopping further hemorrhage, ii. Raising the foot end of the bed iii. Blood transfusion, or substitute of plasma) dextran or saline soln. iv. Sedation & relief of pain by morphine pethidine. 3. Shock due to burn- i. Morphine & saline. ii. Fluid loss due to vomiting & diarrhoea- i.v saline, iii Toxemia- parenteral antibiotic, iv. Acidosis- i.v fluid & sodium bicarbonate. 4. Hypovolemic shock- i. Vasoconstrictor drug- aramine, methidrine, noradrenaline & saline is given, ii. Operation in continuing internal hemorrhage, to correct peritonitis, & resect gangrenous bowel, iii. O2 is given also. |
| Introduction | Shock is a symptom & sign of low tissue perfusion which is inadequate for normal cellular metabolism. In other words, shock is a consequence, which occurs when the rate of arterial blood flow is inadequate to meet tissue metabolic needs. As a result, there is regional hypoxia & subsequent lactic acidosis from anerobic metabolism in peripheral tissues as well as eventual end-organ damage & failure. |
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| Preventions | |
| Treatment | |
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| Types | |
| Classification | Classification:1 According to mechanism and causes, shock may be classified as- A. Hypovolemic shock 1. Loss of blood (hemorrhagic shock) 2. Loss of plasma (e.g burn) 3. Loss of fluid & electrolytes (e.g diarrhoea, vomiting) B. Cardiogenic shock 1. Dysrhythmia 2. Cardiac pump failure (as in myocardial infarction, cardiomyopathy) 3. Acute valvular dysfunction (viz. regurgitation due to valvular lesion) 4. Rupture of ventricular septum C. Obstructive shock 1. Tension pneumothorax 2. Cardiac temponade 3. Massive pulmonary embolism 4. Obstructive valvular disease (aortic or mitral stenosis) D. Distributive shock 1. Septic shock 2. Anaphylatic shock 3. Neurogenic shock 4. Vasodilator drug 5. Acute adrenal insufficiency |
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