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Definition of shock
insufficient tissue perfusion och oxygenation
unresponsive to shock treatmet
undiagnosed bleeding? cardiac tamponade? tension pneumothorax? ventilatroy problems? fluid loss? acute gastric distension? MI? Ketoacidosis? hypoadrenalism? neurogen schock?
special case athletes
more blodd volume 15-20%, CO x 6, resting pulse 50 CAVE severe blodd loss but little symptoms
- b blockers --> no responsive takycardia
- Ca--> alter hemorragic response
- insulin --> hypoglycemia
- diuretics --> hypo -K
- NSAID --> adverse platelet function
Must be avoided, core rewarming, external rewarming-.
VD + bradykardia + warm and dry skin
Fluid + atropin (0,5g--> 0,75-1,0g after 10min)
not responding with takykardia
special considerations with elderly
- less sympathetic activity due to deficit in adrenerg receptors
- cardiac compliance decreases
- b-blockers bradykardia!
- preexisting volme depletion
- worse pulmonary completion
- reduced kidney function(worse fluid preservation), longer time to for toxics to exit
BP= CO x VR
--> only resistance increase will give BP increase but not better perfusion
clinical symptoms of shock
pulse rate, BP, pulse character, respiratory rate, skin circulation, pulse pressure
Any patient who is cool and tachycardic ....
... is in shock until proven otherwise.
Tachycardia school age to puberty
Hematocrit and Hemoglobin...
unreliable values fpr determination of shock.