Sunday, May 20, 2012

Doctorese lecture babble -- SHOCK

I figure being a medical student from time to time I should put something Medical-ish on here. But I don't always know what's appropriate, or at least mildly interesting. To the medical person a lot of this is probably a profoundly DUH! matter, and to the non-medical folk it's a lot of jibberish. But, to show that I am indeed not just riding the CTA back and forth for kicks and giggles with nothing to show, here are my notes from a lecture on shock, given by Dr. Not-House at Chicago Hope Hospital. I'm keeping it as I wrote it, abbreviations and all, for those who might be interested to see exactly how Medicalese looks.


·      Inadequate delivery of oxygen to the tissues – lack of tissue oxygenation, leading to imbalance between oxygen delivery and consumption

DelO2 = CO x ConcaO2


-       CaO2 = RBC + Cp = (1.34xHbxsats) + (PaO2x0.003)

-       RBCs

-       Cp = PaO2x0.003
-       Hb sats

CO = HR x SV

 Preload (CVP)
Cp (=PaO2x0.003)
-  Afterload (SVR)

1.     Hypovolemic – MVAs and GE bleeds
a.     MCC: traumatic blood loss
b.     Organ perfusion
                                               i.     Skin
1.     Color
2.     Temperature
3.     Turgor
                                             ii.     Heart
1.     Tachycardia – ALWAYS in children
2.     BP
3.     Pulse quality
                                            iii.     Lungs -- tachypnea
                                            iv.     Brain -- AMS
                                             v.     Kidneys – decreased urine output
c.     Management
                                               i.     Volume replacement
1.     What type?
a.     Isotonic
b.     No glucose – causes osmotic diuresis
c.     No K+ – arrhythmia
d.     Crystalloids
                                                                                                                       i.     Normal saline
                                                                                                                     ii.     Ringer’s lactate
e.     Colloids
                                                                                                                      i.     Blood
                                                                                                                    ii.     FFP
                                                                                                                  iii.     5% albumin
                                                                                                                  iv.     Dextran
                                                                                                                    v.     Synthetic Hb
2.     How much?
a.     Kids – 20mL/kg
b.     Adults – 0.5L
c.     ***Cardiogenic shock will worsen after one bolus***
3.     How fast? – as fast as they will go
                                             ii.     Monitor sats
                                            iii.     Two large-bore peripheral IVs (shorter than central lines, less resistance)
1.     90s for PIV, if not then intraosseous
2.     Tibia – medial surface
3.     Any long bone
4.     Head of sternum in adults
5.     Anything can be given IO
6.     TPN only given IO
d.     blah

2.     Septic –Mortality 30-35%
a.     ABCs
b.     IV access
c.     O2
d.     Labs/cultures
e.     Antibiotics
f.      Vasoactive drugs

Site of Action
Beta > alpha
Alpha > beta

0-5 low
5-15 mid
>15 high


Mostly Beta2

Milrinone (4-6 hour clearance)

Lusitropic effects
Decreased (relaxes smooth muscle)

g.     Steroids and shock – serum cortisol
                                               i.     If low, ACTH stimulating test – if respond, do nothing
                                             ii.     If does not respond, stress-dose steroids à relative adrenal insufficiency
h.     Glucose and shock
                                               i.     Hyperglycemia presents
                                             ii.     Tight glycemic control (80-110)

3.     Cardiogenic
a.     MI
b.     Post ops
c.     Myocarditis
d.     Compensated vs. Uncompensated
4.     Neurogenic – distributive

5.     Anaphylactic – Distributive, histamine

6.     Obstructive – outward flow obstruction

a.     Acute tamponade
b.     Tension pneumothorax

7.     Dissociative – CO poisoning

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