SHOCK

By: Siti Nurulismah-Nuramalina-Kauthar-Khiddir-Norashikin-Bashirah-Fazwan

 Shock is "a momentary pause in the act of death."-John Collins Warren Mid 1800s

Source: Oregon Health & Science University ; http://ohsu-hca.blogspot.com/

ismah

23/9/2012

What is shock?
A state in which the oxygen and metabolic demands of the body are not met by the cardiac output

Source: An Introduction to Clinical Emergency Medicine. Swaminatha V.M and Gus M.G. Cambridge University Press; 2005.

ismah

23/9/2012

Classification
hypovolemic

cardiogenic

SHOCK
obstructive

distributive

Source: An Introduction to Clinical Emergency Medicine. Swaminatha V.M and Gus M.G. Cambridge University Press; 2005.
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Hypovolemic Shock

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23/9/2012

Definition
The loss of intravascular volume

Source: An Introduction to Clinical Emergency Medicine. Swaminatha V.M and Gus M.G. Cambridge University Press; 2005.

ismah

23/9/2012

Causes
Traumatic

Vascular - e.g. ruptured aneurysm, arterial dissection

Gastrointestinal - e.g. bleeding peptic ulcer Pregnancy related - e.g. ruptured ectopic pregnancy
Source: http://emedicine.medscape.com/article/760145-clinical#a0218

ismah

23/9/2012

Classification (Blood loss)

Class I
Blood loss (%, ml) Blood pressure (Systolic, Diastolic) Pulse (bpm) Capillary refill time Respiratory rate Urinary flow rate (ml/h) Extremities Complexion Mental state <15, 750 Unchanged, unchanged Slight tachycardia Normal Normal >30 Color normal Normal Alert

Class II
15-30, 800-1500 Normal, raised

Class III
30-40, 1500-2000 Reduced, reduced

Class IV
>40, >2000 Very low, very low or unrecordable >120, very thready Undetectable Tachypnea, >20/min 0-10 Pale and cold Ashen Drowsy, confused or unconscious

100-120 Slow, >2s Normal 20-30 Pale Pale Anxious or aggressive

120, thready Slow, >2s Tachypnea, >20/min 10-20 Pale Pale Anxious, aggressive or drowsy
8

Source: ABC of Major Trauma. BMJ.

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Types
Hemorrhagic hypovolemic shock - External and internal bleeding
Non hemorrhagic hypovolemic shock - Severe dehydration or fluid losses - E.g. in Diabetic Ketoacidosis, Cholera

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23/9/2012

THANK YOU

ismah

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