The development of shock is related to the alteration of one or more of the four main components that regulate cardiovascular

performance:
1. 2. 3. 4. Circulating blood volume Heart rate, rhythm, and contractility Arteriolar tone, which regulates the arterial blood pressure and tissue perfusion Tone of the venous capacitance system, which regulates the venous return to the heart and the ventricular preload.

Shock can be classified into three categories based on the cause.

Acessing global tissue oxygenation : 3 parameters used : 1. Mixed /arterial venous oxygenation 2. Arterial Blood lactate 3. Difference between mixed venous and arterial Pco2 Management for shock The goals of initial resuscitation are : 1. 2. 3. 4. 5.
6.

MAP > 65mmHg CVP ( 8 -12 mmHg ) Urine output ( > 0,5 ml/kg/hour ) Central venous O2 saturation (>70 % ) if mixed venous O2 saturation(>65 % ) HCT ( 30 % )
a : Neurogenic

Neurogenic shock is associated with bradycardia and a vasoparalysis with a low central venous pressure. b : Septic Septic shock in the established phase is often characterised by a high cardiac index, high central venous oxygen saturation, and low central venous pressure. c : Cardiogenic Cardiogenic shock is most likely. Patients usually have hypotension, reduced central venous oxygen saturation, reduced cardiac index, and a raised central venous pressure. d : Anaphylactic Anaphylactic shock is often characterised by a high cardiac index, high central venous oxygen saturation, and low central venous pressure.

e : Hypovolaemic Hypovolaemic shock is characterised by a low cardiac index, low central venous oxygen saturation, and low central venous pressure.

____________________________________________________ a : Measurement of arterial lactate Measuring arterial lactate levels is part of the resuscitation bundle for sepsis. b : Titrate therapy to achieve an ScvO2 >70% Achieving an ScvO2 >70% is part of the resuscitation bundle for sepsis. c : Administration of antibiotics within one hour of diagnosis Administration of antibiotics within one hour of diagnosis is part of the resuscitation bundle for sepsis. d : Use of low dose of steroids Low dose of steroids is part of the management bundle for sepsis and, therefore, is NOT is part of the resuscitation bundle for sepsis. e : CVP target 8-12 mm Hg Achieving a CVP of 8-12 mm Hg is part of the resuscitation bundle for sepsis. f : MAP >65 mm Hg Achieving a MAP >65 mm Hg is part of the resuscitation bundle for sepsis.

Several clinical features that are common and should be promptly recognised:

Cool, clammy, with weak pulses (hypodynamic) or warm, dilated peripheries with bounding pulses (hyperdynamic)

Altered mental status Oliguria Hypotension or postural fall in blood pressure Metabolic acidosis.