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    Shock: Docente: Dra. Luísa Quaresma

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    Elena Amaral
    The document discusses shock, defining it as a life-threatening condition caused by low blood flow to tissues. It classifies shock into several types including hypovolemic, cardiogenic, obstructive, and inflammatory shock. The document covers the pathophysiology, etiology, clinical signs, diagnosis, and treatment of different types of shock.

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    Shock: Docente: Dra. Luísa Quaresma

    Uploaded by

    Elena Amaral
    28 views29 pages
    The document discusses shock, defining it as a life-threatening condition caused by low blood flow to tissues. It classifies shock into several types including hypovolemic, cardiogenic, obstructive, and inflammatory shock. The document covers the pathophysiology, etiology, clinical signs, diagnosis, and treatment of different types of shock.

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    The document discusses shock, defining it as a life-threatening condition caused by low blood flow to tissues. It classifies shock into several types including hypovolemic, cardiogenic, obstructive, and inflammatory shock. The document covers the pathophysiology, etiology, clinical signs, diagnosis, and treatment of different types of shock.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    28 views29 pages

    Shock: Docente: Dra. Luísa Quaresma

    Uploaded by

    Elena Amaral
    The document discusses shock, defining it as a life-threatening condition caused by low blood flow to tissues. It classifies shock into several types including hypovolemic, cardiogenic, obstructive, and inflammatory shock. The document covers the pathophysiology, etiology, clinical signs, diagnosis, and treatment of different types of shock.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 29

    SHOCK

    Docente: Dra. Luísa Quaresma


    Polo de Ensino: Hospital Curry Cabral

    Unidade Curricular
    CIRURGIA GERAL – 3º Ano
    UC CIRURGIA GERAL – 3º Ano | CHOQUE

    • Definition
    • Classification
    • Pathophysiology
    • Etiology
    Objectives • Clinical Semiology in Hypovolemic
    shock
    • Treatment
    • Clinical Cases
    UC CIRURGIA GERAL – 3º Ano | CHOQUE

    Definition

    Life-threatening medical condition of low


    blood perfusion to tissues resulting in cellular
    injury and inadequate tissue function
    UC CIRURGIA GERAL – 3º Ano | CHOQUE

    Classification

    HYPOVOLEMIC CARDIOGENIC COMPRESSIVE INTRAVASCULAR


    OBSTRUCTIVE

    INFLAMATORY NEUROGENIC
    UC CIRURGIA GERAL – 3º Ano | CHOQUE

    Pathophysiology

    Cardiac output = systolic volume x heart rate

    Arterial pressure = Cardiac output x vascular resistance


    UC CIRURGIA GERAL – 3º Ano | CHOQUE

    Pathophysiology

    Hypovolemic – Cardiogenic- Disruption


    Diminution of tele of cardiac muscle
    diastolic ventricular contractility or cardiac
    pressure ( pré-load). rhythm disorders.

    Intravascular
    Compressive-Extrinsic
    Obstructive- After Load
    compression of the
    Increase (arteries and
    heart or great vessels
    microcirculation).
    UC CIRURGIA GERAL – 3º Ano | CHOQUE

    Pathophysiology

    • Neurogenic- Autonomic dysfunction in


    vessel innervation
    (decreased after-load).

    • Inflamatory- Cytokin storm, pro


    coagulants release
    (decreased after-load).
    UC CIRURGIA GERAL – 3º Ano | CHOQUE

    • Bleeding
    • Vomiting
    Etiology • Diarrhea
    Hypovolemic • Intestinal oclusion
    shock • Dehydration
    • “Third space”fluid retention
    • Adrenal Insuffiency
    • Insipidus Diabetes
    UC CIRURGIA GERAL – 3º Ano | CHOQUE

    Etiology
    Obstructive schock

    Cardiac tamponade
    Hypertensive pneumothorax
    Positive pressure Ventilation
    Pregnancy
    Diaphragmatic hernia
    Abdominal compartment syndrome
    UC CIRURGIA GERAL – 3º Ano | CHOQUE

    Etiology
    Intravascular obstructive shock

    Aortic stenosis
    Pulmonary embolism
    High blood Pressure
    UC CIRURGIA GERAL – 3º Ano | CHOQUE

    Etiology
    Cardiogenic shock

    ACUTE MIOCARDIAL ARRHYTHMIA


    MYOCARDIAL HYPERTROPHY
    INFARCTION
    UC CIRURGIA GERAL – 3º Ano | CHOQUE

    Etiology
    Neurogenic shock

    SPINAL CORD REGIONAL SYMPATHETIC


    INJURY ANESTHESIA NERVOUS SYSTEM
    BLOCKADE
    UC CIRURGIA GERAL – 3º Ano | CHOQUE

    Etiology
    Inflamatory shock

    SIRS
    Acute Pancreatitis

    Infection-Septic shock
    UC CIRURGIA GERAL – 3º Ano | CHOQUE
    UC CIRURGIA GERAL – 3º Ano | CHOQUE
    UC CIRURGIA GERAL – 3º Ano | CHOQUE

    Semiology

    Skin

    Colour
    Temperature
    Texture

    Hemodynamic parameters
    Normal Blood Pressure
    Low Blood Pressure
    Tachycardia
    Bradycardia
    UC CIRURGIA GERAL – 3º Ano | CHOQUE

    Semiology

    3. Respiratory rate
    Tachypnea

    4. Neurological status
    Agitation

    5. Urinary flow
    Oligúria
    Anúria
    UC CIRURGIA GERAL – 3º Ano | CHOQUE

    Semiology
    Jugular Cardiac
    Type Skin RVP
    veins output

    Hypovolemic Pale, cold

    Pale, cold
    Cardyogenic

    Séptic
    Pink, warm
    inicial

    Séptic tardio Pale, cold

    Neurogenic Pink, warm


    UC CIRURGIA GERAL – 3º Ano | CHOQUE

    Hypovolemic shock
    Blood loss(%)
    <15 15-30 30-40 >40

    Perda sangue
    <750 750-1500 1500-2000 >2000
    (ml)
    Frequência
    normal >100 >120 >140
    cardíaca
    Pressão arterial
    sistólica normal normal

    Pressão arterial
    diastólica normal

    Frequência
    Manifestações clinicas-
    normal
    respiratória Choque hipovolémico
    Estado ansiedade
    ansiedade confusão letargia
    neurológico moderada
    Débito urinário normal oligúria anúria
    UC CIRURGIA GERAL – 3º Ano | CHOQUE

    Diagnostic tests

    1. Arterial gas analysis


    Hipoxemia
    Lactic acid increase
    Metabolic acidosis

    2. Venous blood analysis


    haemograme
    Renal function tests
    Cardiac enzymes markers
    UC CIRURGIA GERAL – 3º Ano | CHOQUE
    UC CIRURGIA GERAL – 3º Ano | CHOQUE
    UC CIRURGIA GERAL – 3º Ano | CHOQUE
    UC CIRURGIA GERAL – 3º Ano | CHOQUE
    UC CIRURGIA GERAL – 3º Ano | CHOQUE

    Treatment

    1. General

    Oxigen supplementation
    Fluid substituition
    Blood transfusion
    Vasoconstrictive drugs

    2. According to etiology
    UC CIRURGIA GERAL – 3º Ano | CHOQUE

    CASO CLÍNICO
    • Homem, 65 anos
    • Acidente de viação

    • Agitado
    • Dor torácica esquerda
    • PA sist-75 mmhg
    UC CIRURGIA GERAL – 3º Ano | CHOQUE

    CASO CLÍNICO
    • Homem, 18 anos
    • Hemofilia B e HIV +
    • Lipotimia
    • Obnubilado
    • PA sist 70 mmhg
    UC CIRURGIA GERAL – 3º Ano | CHOQUE

    CASO CLÍNICO
    • Sexo masculino, 75 anos

    • Febre-39º
    • Taquipneia
    • PA sist-120 mmhg
    UC CIRURGIA GERAL – 3º Ano | CHOQUE

    CASO CLÍNICO
    • Mulher, 42 anos

    • Pós operatório imediato


    • Lipotimia
    • PA sist-85 mmhg

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