SHOCK FOR BEGINNER

Pre HO Medicorp KB

Cardiogenic Shock

• Pt concious

• BP < 90/60

• Most common cause : Myocardial Infarction

• Kena buat ECG - Contohnya nampak ada changes,

ST Elevation

• Principle of treatment ;

1. Tx underlying cause (eg Myocardial Infarction)

Thrombolytic Therapy

• PCI

• Streptokinase -100 mega unit/ 100 cc /Hour

2. Symptomatic TX (eg : Chest pain)

» Pain Killer

IV Morphine 2-2.5mg every 5 min

(Targeted pain score 0-1) - well controlled pain

No maximum dose for morphine

(As long as sedation score 0-1, no limit to give morphine)

 (If sedation score 2,3 can give IV Fentanyl 50 mcg - 100

mcg)

! kena optimize pain control, sebab boleh worsen MI kalau

sakit persistent. Nak pain score 0- 1.

∆ Oxygen?

Precaution to use, sebab can cause worsen necrosis,

oxidative stress to heart.

Unless if spo2 drop, can start with 1L first, then 2L per

minute

∆ Nitrates

» ? Contraindicated in cardiogenic shock

∆ Inotropes

Example : Dopamine, Dobupamine, Noradrenaline

√ 1st line inotropes in cardiogenic shock, dopamine

√ Other type of shock, 1st line - noradrenaline.

BP : Stroke Volume x Total Peripheral Resistance

69

Haemorhagic Shock

What if patient that post op (eg laparotomy), suddenly BP drop?

• Check Temp

» Fever : Septic shock

• Check Hb

» HB low: Haemorrhagic shock

What to do as HO (if haemorrhagic shock?)

• Prepare patient

• Form

• Symptomatic -  Blood tx - after d/w MO

• Berapa pint? Whole blood ke pack cell?

• Pack cell. Hb aim > 10, 1 pint akan membuat HB

naik sampai 1 - 1.5g

Sambil awaiting pack cell?

(Sejam biasanya blood bank nak prepare blood)

» Can give IV bolus normal saline : 20cc/kg/

Hour

Hypovolumic Shock

Example in case :

1. DKA

2. Burn

DKA

• CBS >11 (Capillary blood sugar)

• PH < 7.3

• HCO3 < 15

◊ IX

• UFEME

• VBG

◊ Why dalam DKA BP drop?

Fluid enter intracellular due to hyperlgycemia in cell.

So treatment underlying cause is by reduce high glucose.

◊ Inotropes of choice?

IV Noradrenaline.

◊ If patient burn?

Loss circulating volume due to burn.

◊ Tx underlying factor?

• Put pt on dressing, pt on antibiotic

• Prevent infection

• IV NS 20 cc/ KG/ Hr

◊ Septic shock :

 Tx same as hypovolemic shock but +

Antibiotic

****

◊ Apa beza allergic reaction/anaphylaxtic/ anaphylaxis shock

• Allergic : Urticaria (skin n mucus membrane)

• Anaphylaxtic : urticaria (skin n mucus membrane n

systemic( respiratory +/- cardiovascular)

• Anaphylaxic shock : anaphylaxtic reaction and BP

drop

» Tx : IM Adrenaline : 0.5 mg at lateral tigh,

wait for 5 min, if sx resolve, tak perlu buat

apa-apa

» If not resolve, give second dose but in

contralateral side

» If still not resolve : IV Adrenaline ( only can

be given if planned by specialist)

◊ IV adrenaline most case use if patient yang case asystole je

◊ Symptomatic tx

» IV Hydrocort 200mg

» T Prednisolone 30mg (Both same efficacy)

» IV Piriton / Syr Piriton

» IV Ranitidine (help reduce hypersensitivity

and GI symptom)

» Inotropes : IV Noradrenaline : need to give

only if pt given IM Adrenaline already. If pt on

triple inotropes, refer anest.

Spinal Shock

Cause cth: MVA - vetebral injury and fracture

BP okey?

Boleh tunggu turn for operation.

Tapi some case BP can drop.

Why in spinal shock BP boleh drop?

• Sebab injury to nerve innervate blood vessel

• Spinal cord f(x) nya maintain blood vessel tone

• Treatment by IV Noradrenaline : help in

vasoconstrict and increase BP

Kredit to Dr Hilmi (Husband Dr Iliana) in PreHO KB by

Medicorp kerana ajar kami tajuk ni.