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IN MULTIPLE INJURY
PKI 5002
Definition
6 CO2
6 O2
6 H2O
GLUCOSE
METABOLISM
36 ATP
2 LACTIC ACID
2 ATP
GLUCOSE
METABOLISM
HEAT (32 kcal)
CONSEQUENCE OF ANAEROBIC
METABOLISM
Inadequate cellular
Oxygen delivery
Inadequat
e energy Lactic acid
Anaerobic
production production
metabolism
Metabolic Metabolic
Cell Death
failure acidosis
The three essential patterns of circulatory
shock
SHOCK SYNDROMES
• Hypovolaemic Shock
– blood VOLUME problem
• Cardiogenic Shock
– blood PUMP problem
• Distributive Shock
– blood VESSEL problem
Hypovolemic Shock
• = “Low Volume ”
• Aetiology:
–Internal or external fluid loss
–Intracellular and extracellular compartment
• Most common causes:
–Haemorrhage
–Dehydration (non-haemorrhagic)
Pathophysiology Hypovolaemic Shock
Decreased intravascular volume
Decreased CO
• Hemorrhage control
• Restore volume
• Optimize oxygen delivery
– Enough circulating red cell
– Red cell oxygenation
– Red cell delivery
Fluid Resuscitation
• Crystalloids
– Such as sodium chloride (0.9%) or
– Lactated Ringer’s solution (Hartmann's solution)
– Dextrose solutions which contain free water are
less effective at re-establishing circulating volume
and promote hyperglycemia.
cont
• Colloids
– For example, polysaccharide (Dextran), polygeline
(Haemaccel), succinylated gelatin (Gelofusine) and
hetastarch (Hespan).
– Much more expensive than crystalloid solutions
• Combination
– colloids and crystalloids
• Blood
– Essential in severe hemorrhagic shock, often pre-
warmed and rapidly infused
Cardiogenic Shock
• The impaired ability of the heart to pump
blood
• Pump failure of the right or left ventricle
Etiology Cardiogenic Shock
• Pump Failure • Obstructive
– Acute M I (Mechanical flow
– CHF obstruction)
– Bradyarrhythmias – Tension
– Tachyarrhythmias pneumothorax
– Cardiomyopathy – Pulmonary embolism
– Cardiac tamponade
Pathophysiology Cardiogenic Shock
Impaired pumping
ability of LV