The four core types of shockcardiogenic, hypovolemic, obstructive, and vasoplegiccan readily be identified by echocardiography. The major cause of unstability in polytrauma patients diagnosed by rush is hypovolemic shock 64%, followed by obstructive, whose second and third causes are respectively cardiogenic shock and. In obstructive shock, its actually very similar except the. Undifferentiated shock refers to the situation where shock is recognized but the cause is unclear. The high dynamics of this potentially lifethreatening condition is a hallmark of all types of obstructive shock. Patients with no focal symptoms or signs indicative of cause should have ecg, cardiac enzymes, chest xray, and abgs. In obstructive shock, its actually very similar except the issue here is its an obstruction. Now, this will be an advanced coverage of all the different types of shock, so most of my detail will be very brief, and give you a. Pulmonary embolism and cardiac tamponade are considered forms of obstructive shock.
Obstructive shock definition of obstructive shock by. Obstructive shock is very similar to cardiogenic shock. Distributive shock septic shock anaphylactic shock neurogenic shock. Diagnosis of shock shock may be suspected based on the history given predation, vehicle. When large numbers of cells are bypassed by oxygenated blood, an imbalance in oxygen demand and delivery develops that can lead to shock. A free powerpoint ppt presentation displayed as a flash slide show on id. View and download powerpoint presentations on hypovolemic shock ppt. Ppt obstructive shock powerpoint presentation free to. The most simple physiology of shock is cardiogenic. The heart does not have the space to pump effectively. If results of these tests are normal, the most likely causes include drug overdose, occult infection including toxic. Obstructive shock article about obstructive shock by.
Obstructive shock occurs when adequate oxygen and nutrient delivery to the organs and tissues of the body is compromised as a direct result of an obstruction to blood flow into or out of the heart. Obstructive shock cardiac tamponade arterial stanosis pulmonary embolus pulmonary htn constrictive pericarditis thoracic tumors tension pneumothorax indirect pump failure pathophysiology and etiology risk factors clinical manifestation collaboration the who, what, where, and when diagnostic test pharmacologic therapies clinical therapies. Ppt shock powerpoint presentation, free download id. Circulatory shock, commonly known simply as shock, is a lifethreatening medical condition that occurs due to the provision of inadequate substrates for cellular respiration. We present the case of a 69yearold woman with endstage hypertrophic obstructive cardiomyopathy who developed cardiogenic shock. Obstructive shock article about obstructive shock by the.
Neurogenic shock is rare, and its diagnosis is commonly delayed. Pulmonary embolism has a variable hemodynamic presentation depending on the clot burden and the extent of obstruction in the pulmonary vasculature. Pediatric shock recognition, classification and initial management critical concepts course recognition and classification initial management of shock final thoughts recognize compensated shock quickly have a high index of suspicion, remember tachycardia is an early sign. Obstructive shock is a less common, but important cause of shock in critically ill infants and children. Primitive men and women, in their struggle for existence, survived or died of shock from injury, trauma, hemorrhage and sickness. See also the pulmccm topic, vasopressors for septic shock. Treatment of obstructive shock the additional option for treatment of obstructive shock from pneumothorax is needle tho. Obstructive shock cardiac tamponade arterial stanosis pulmonary embolus pulmonary htn constrictive pericarditis thoracic tumors tension pneumothorax indirect pump. Circulatory collapse caused by conditions that block the flow of blood into or out of the heart, such as cardiac tamponade, cardiac tumors, massive pulmonary embolism, or tension pneumothorax. Loss of blood hemorrhagic shock external hemorrhage trauma gastrointestinal. Obstructive shock describes shock associated with vascular obstructive defects including pulmonary embolism, pericardial tamponade, atrial myxoma, tension pneumothorax, hydrothorax or haemothorax and even ascites.
Obstructive shock occurs when the heart cannot work properl y for a physical reason. Typical symptoms of shock include elevated but weak heart rate, low blood pressure, and poor organ function, typically observed as low urine output, confusion, or loss of consciousness. Obstructive shock, pneumothorax, cardiac tamponade, pulmonary embolus. Causes include cardiac tamponade, pulmonary embolism and narrowing of the aortic artery. Obstructive shock as the name implies, is associated with obstruction of the heart or the great vessels. So, i want to create one final video on shock, and this is the video to really compare all the different types of shock, and see how you can differentiate between them. Cardiogenic, obstructive, hypovolemic, and distributive. Pathophysiology heart pumps well, but the output is. Despite new insights into pathophysiology and new horizons for treatment, the main principles of management remain the rapid and complete repletion of circulating blood volume and treatment of the.
Obstructive shock is caused by the inability to produce adequate cardiac output. Percutaneous ventricular assist device in hypertrophic. Shock or its equivalent, by whatever name the era in question gave it, has been known since man came on the earth. Obstructive shock is characterized by very low cardiac output and increased systemic vascular resistance.
We present a rapidly fatal case of obstructive shock where a vigilant intensivist could diagnose left atrial mass obstructing the mitral inflow as the etiology of shock. Even within each of the main headings contained in the shock classification, a variety of pathologies may be the cause and echocardiography will differentiate which of these is responsible. Hypovolemic shock is defined as the rapid fluid loss or. A man in his 50s presenting with rapidonset dyspnea and. Objective of the study was to appreciate prevalence and main clinical features of obstructive shock os in patients with pe admitted to our departement, and to evaluate thrombolytic therapy effectiveness bape regimen. Pediatric considerations neonates consider congenital obstructive left heart syndrome as cause of obstructive shock oliguria shock2. Shock is a lifethreatening condition involving insufficient blood flow to the body tissues.
Septic shock, a form of distributive shock, is the most common form of shock among patients admitted to the intensive care unit, followed by cardiogenic and. Septic shock, a form of distributive shock, is the most common form of. Obstructive shock differentiate from hypovolemic shock by signs and. Obstructive shock is caused by some sort of significant blockage in blood flow, usually near either the heart or lungs pulmonary circulation, which leads to low blood pressure and eventual organ. It is caused by mechanical obstruction of blood flow to andor from the heart and causes can include a tension pneumothorax, cardiac tamponade, pulmonary embolus, or cardiac defects resulting in leftsided outflow tract obstruction. Obstructive shock is caused by obstruction the blood flow. The clinical presentation often is confusing, perhaps. If blood flowing into the heart is obstructed, it causes a decrease in cardiac output because of impaired diastolic filling.
Hypovolemic shock an overview sciencedirect topics. Echocardiography in shock management critical care. Neurogenic shock is ruled out quickly by observing patients moving all their extremities. Obstructive shock is a form of shock associated with physical obstruction of the great vessels or the heart itself. Upon arrival, he was found to be in moderate distress. Hypovolemic shock cardiogenic shock obstructive shock distributive shock. A man in his 50s with no relevant medical history experienced rapidly progressive dyspnea over 2 days and presented to the ed. Pathophysiology and management of different types of shock. In cardiogenic shock, the problem is the heart is not able to squeeze properly and pump blood forward.
She underwent emergent placement of a percutaneous left ventricular assist device tandemheart in the catheterization lab as a bridge support device until a septal myectomy could be performed as definitive treatment. Cardiovascular emergencies advanced life support successful treatment of cardiogenic shock involves minimizing the volume of fluid administered and early consideration of a vasopressor. A collection of questions from content covered on the nclexrn. Pathophysiology heart pumps well, but the output is decreased due to an obstruction in or out of the heart map co x svr hr x stroke volume if the blood outflow from the heart is decreased because there is decreased return to the heart due to an obstruction or obstructed as the blood leaves the heart the stroke. Circulatory shock boundless anatomy and physiology. The accumulation of blood outside the heart, but inside the sac of the heart, known as tamponade, is an example. Acsase medical student core curriculum shock shock is a life.
Obstructive shock an overview sciencedirect topics. To prioritize your interventions, remember how patients cohde. It leads to distinctive symptoms and signs, initially of compensation and later of failure. And thats actually why i have this heart drawn out right here. Distributive shock septic shock anaphylactic shock neurogenic shock 14. Obstructive shock has much in common with cardiogenic shock, and the. Obstructive shock cardiac tamponade andor tension pneumothorax should be reconsidered, and if any doubt remains, steps should be taken to correct this. Shock, obstructive symptoms, diagnosis, treatments and. Find powerpoint presentations and slides using the power of, find free presentations research about hypovolemic shock ppt. Find powerpoint presentations and slides using the power of, find free presentations research about shock ppt. Groeneveld, in critical care medicine third edition, 2008. Hypovolemic shock is a lifethreatening condition, necessitating prompt diagnosis and therapy to prevent mof and death. Your patients shock may be multifactorial, but mentally prioritize what you think is the main case of the shock, and deal with that first.
Shock is a clinical state in which disparity of oxygen supply and demand at cell level results in tissue hypoxia and incipient failure of cell function. Definition, classification, etiology, and pathophysiology of shock in. Obstructive shock is when a person goes into shock as a result of an obstruction or blockage or the great blood vessels such as the aorta, or of the heart itself. View and download powerpoint presentations on shock ppt. From a hemodynamic viewpoint circulatory shock caused by obstruction is closely followed by cardiac deterioration.
Obstructive shock is a lifethreatening emergency that occurs when there is a problem with the functioning of the heart. Anand kumar, md section of critical care medicine section of infectious diseases university of manitoba, winnipeg, canada umdnjrobert wood johnson medical school cooper hospital, nj shock pathophysiology, classification, and approach to management. In effect, there is inadequate effective cardiac output eco to provide the appropriate oxygen delivery. The four takehome points in the approach to shock in children. Obstructive shock circulatory system and disease nclex. Training in echocardiography is essential for an intensivist.
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