emergency medicine

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  1. poor perfusion --> oxygen delivery=
  2. classification of shock
    • many types and much overlap
    • all have poor perfusion in common
    • cardiogenic
    • distributive
    • obstructive
    • hypovolemic
  3. cause of shock
  4. treatment goal for shock
    optimize O2 delivery
  5. oxygen delivery
    • amount or volume of O2 transported to the tissues each minute
    • product of cardiac output and O2 content
    • important concept rather than actual measurement
  6. cardiogenic shock
    • heart failure alone-not associated with outside problems (caval syndrome, tamponade)
    • example of causes is cardiomyopathy (HCM or DCM), vascular disease (MI, AO/AS), arrhythmias, fibrosis
  7. distributive shock
    • associated with flow maldistribution
    • example of causes-sepsis, anaplylaxis, trauma, neurogenic¬† causes
  8. obstructive shock
    • obstruction in the circulatory system
    • example of causes- heartworm disease (caval syndrome), pericardial effusion, pulmonary embolism, GDV
  9. hypovolemic shock
    • most common form of shock
    • associated with decreased vascular volume- could say reduced preload
    • example of causes- blood loss, third spacing, excessive losses externally (vomiting, diarrhea, polyuria)
    • initial insult occurs
    • intravascular volume decreases
    • preload (venous return and ventricular volume) decreases
    • stroke volume and therefore CO decrease
    • SHOCK
  10. recognizing shock-history
    • good information from the owner
    • trauma
    • PU/PD
    • V/D
    • "I found him this way"
  11. recognizing shock- physical exam
    • stage 1- compensated shock
    • stage 2- decompensated shock
    • stage 3- irreversible shock
  12. compensated shock
    • early stage-very treatable
    • tachycardia
    • decreased pulse quality
    • prolonged CRT
    • pale MM
    • cool extremities
  13. decompensated shock
    • more severe state- very aggressive therapy
    • tachycardia
    • poor quality to absent pulses
    • CRT variable
    • muddy MM
    • low BP
    • obtunded mental status
  14. irreversible shock
    • severe systemic hypoperfusion
    • treatments no longer affective
    • "do you want this dog, or a dog"
  15. treatment of shock
    • oxygen therapy
    • fluid resuscitation
    • medical management
    • monitoring/assessing results
  16. oxygen
    • provided immediately at high flow rates
    • if RR, effort, and MM not improving with O2
    • inadequate ventilation
    • pneumo-, hemo-rib fx, diaphragmatic hernia, or severe contusions
    • thoracentesis if sounds dull or suspect pleural dz
    • radiographs if negative
    • contused side down/ventilation
    • inadequate pulmonary circulation
  17. intubation
    • intubate in lateral recumbency
    • auscult bilaterally after intubation
    • tracheostomy tube if cannot intubate because of oral, pharyngeal, or laryngeal injuries
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emergency medicine
2014-02-23 03:47:23

chapter 12
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