Patients with no focal symptoms or signs indicative of cause should have ecg, cardiac enzymes, chest xray, and abgs. Groeneveld, in critical care medicine third edition, 2008. Pathophysiology heart pumps well, but the output is. The most simple physiology of shock is cardiogenic. 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. 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. In obstructive shock, its actually very similar except the. A free powerpoint ppt presentation displayed as a flash slide show on id. The clinical presentation often is confusing, perhaps. Ppt shock powerpoint presentation, free download id. A man in his 50s presenting with rapidonset dyspnea and.
In obstructive shock, its actually very similar except the issue here is its an obstruction. In effect, there is inadequate effective cardiac output eco to provide the appropriate oxygen delivery. 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. Distributive shock septic shock anaphylactic shock neurogenic shock. Obstructive shock cardiac tamponade arterial stanosis pulmonary embolus pulmonary htn constrictive pericarditis thoracic tumors tension pneumothorax indirect pump. Percutaneous ventricular assist device in hypertrophic. Pulmonary embolism and cardiac tamponade are considered forms of obstructive shock.
View and download powerpoint presentations on hypovolemic shock ppt. Hypovolemic shock cardiogenic shock obstructive shock distributive shock. Obstructive shock occurs when the heart cannot work properl y for a physical reason. 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. Hypovolemic shock an overview sciencedirect topics. Loss of blood hemorrhagic shock external hemorrhage trauma gastrointestinal. 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. The four takehome points in the approach to shock in children. Echocardiography in shock management critical care. Obstructive shock an overview sciencedirect topics. A collection of questions from content covered on the nclexrn.
Obstructive shock as the name implies, is associated with obstruction of the heart or the great vessels. Obstructive shock is caused by obstruction the blood flow. It leads to distinctive symptoms and signs, initially of compensation and later of failure. 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. 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.
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. Circulatory shock, commonly known simply as shock, is a lifethreatening medical condition that occurs due to the provision of inadequate substrates for cellular respiration. Cardiogenic, obstructive, hypovolemic, and distributive. 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.
And thats actually why i have this heart drawn out right here. Diagnosis of shock shock may be suspected based on the history given predation, vehicle. If results of these tests are normal, the most likely causes include drug overdose, occult infection including toxic. Neurogenic shock is ruled out quickly by observing patients moving all their extremities. 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. 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. The four core types of shockcardiogenic, hypovolemic, obstructive, and vasoplegiccan readily be identified by echocardiography. 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.
When large numbers of cells are bypassed by oxygenated blood, an imbalance in oxygen demand and delivery develops that can lead to shock. Undifferentiated shock refers to the situation where shock is recognized but the cause is unclear. Obstructive shock describes shock associated with vascular obstructive defects including pulmonary embolism, pericardial tamponade, atrial myxoma, tension pneumothorax, hydrothorax or haemothorax and even ascites. Shock or its equivalent, by whatever name the era in question gave it, has been known since man came on the earth. Definition, classification, etiology, and pathophysiology of shock in. Neurogenic shock is rare, and its diagnosis is commonly delayed. The heart does not have the space to pump effectively.
We present the case of a 69yearold woman with endstage hypertrophic obstructive cardiomyopathy who developed cardiogenic shock. Acsase medical student core curriculum shock shock is a life. Circulatory shock boundless anatomy and physiology. Obstructive shock, pneumothorax, cardiac tamponade, pulmonary embolus. Obstructive shock cardiac tamponade andor tension pneumothorax should be reconsidered, and if any doubt remains, steps should be taken to correct this. Obstructive shock article about obstructive shock by. 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. Pathophysiology and management of different types of shock. Treatment of obstructive shock the additional option for treatment of obstructive shock from pneumothorax is needle tho.
Obstructive shock is a form of shock associated with physical obstruction of the great vessels or the heart itself. A man in his 50s with no relevant medical history experienced rapidly progressive dyspnea over 2 days and presented to the ed. 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. Hypovolemic shock is a lifethreatening condition, necessitating prompt diagnosis and therapy to prevent mof and death.
Obstructive shock is characterized by very low cardiac output and increased systemic vascular resistance. Obstructive shock definition of obstructive shock by. Distributive shock septic shock anaphylactic shock neurogenic shock 14. Obstructive shock is caused by the inability to produce adequate cardiac output. Obstructive shock circulatory system and disease nclex. Cardiovascular emergencies advanced life support successful treatment of cardiogenic shock involves minimizing the volume of fluid administered and early consideration of a vasopressor. Find powerpoint presentations and slides using the power of, find free presentations research about shock ppt. In cardiogenic shock, the problem is the heart is not able to squeeze properly and pump blood forward. Pediatric considerations neonates consider congenital obstructive left heart syndrome as cause of obstructive shock oliguria shock2. Obstructive shock article about obstructive shock by the. Obstructive shock differentiate from hypovolemic shock by signs and.
Hypovolemic shock is defined as the rapid fluid loss or. Shock is a lifethreatening condition involving insufficient blood flow to the body tissues. See also the pulmccm topic, vasopressors for septic shock. Ppt obstructive shock powerpoint presentation free to.
Causes include cardiac tamponade, pulmonary embolism and narrowing of the aortic artery. Septic shock, a form of distributive shock, is the most common form of. 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. 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. To prioritize your interventions, remember how patients cohde. Upon arrival, he was found to be in moderate distress. 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. Obstructive shock is a lifethreatening emergency that occurs when there is a problem with the functioning of the heart. 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. View and download powerpoint presentations on shock ppt. If blood flowing into the heart is obstructed, it causes a decrease in cardiac output because of impaired diastolic filling. Obstructive shock is a less common, but important cause of shock in critically ill infants and children.
Obstructive shock is very similar to cardiogenic shock. The accumulation of blood outside the heart, but inside the sac of the heart, known as tamponade, is an example. The high dynamics of this potentially lifethreatening condition is a hallmark of all types of obstructive shock. Pulmonary embolism has a variable hemodynamic presentation depending on the clot burden and the extent of obstruction in the pulmonary vasculature. From a hemodynamic viewpoint circulatory shock caused by obstruction is closely followed by cardiac deterioration. Primitive men and women, in their struggle for existence, survived or died of shock from injury, trauma, hemorrhage and sickness. Obstructive shock has much in common with cardiogenic shock, and the. Training in echocardiography is essential for an intensivist. Your patients shock may be multifactorial, but mentally prioritize what you think is the main case of the shock, and deal with that first. 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.
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