复旦大学：《内科学 Internal Medicine MBBS》课程教学资源（课件讲稿）重症监护医学_Shock（一）

SHOCK Shao mian Emergency Department, Zhongshan Hospital

Shao Mian Emergency Department，Zhongshan Hospital SHOCK

WHAT IS SHOCK Claude bernard Thomas buzzard

WHAT IS SHOCK Claude Bernard Thomas Buzzard

WHAT IS SHOCK THE BEGINNINGS OF UNDERSTANDING: THE LATE 19TH CENTURY THE AGE OF REASON: 1890-1925 THE MODERN ERA: BLALOCK'S EPIPHANY POSTMODERNISM: CELLULAR PHYSIOLOGY OF SHOCK 1945-1965 REACHING THE NEW MILLENNIUM: 1990--PRESENT

WHAT IS SHOCK • THE BEGINNINGS OF UNDERSTANDING: THE LATE 19TH CENTURY • THE AGE OF REASON: 1890—1925 • THE MODERN ERA: BLALOCK’S EPIPHANY • POSTMODERNISM: CELLULAR PHYSIOLOGY OF SHOCK 1945—1965 • REACHING THE NEW MILLENNIUM: 1990--PRESENT

WHAT IS SHOCK A physiologic state characterized by Inadequate tissue perfusion imbalance between the delivery of and requirements for oxygen and substrate Clinically manifested by Hemodynamic disturbances Organ dysfunction

WHAT IS SHOCK • A physiologic state characterized by • Inadequate tissue perfusion • imbalance between the delivery of and requirements for oxygen and substrate • Clinically manifested by • Hemodynamic disturbances • Organ dysfunction

CLASSES OF SHOCK THE HEMODYNAMIC EQUATION BP CO SVR (blood pressure) (cardiac output) (systemic vascular resistance) CO stroke volume(SV)x heart rate SV end diastolic volume(EDV)-end systolic volume(ESV) (preload) affected by afterload/inotropy/ EDV= venous return ESv

CLASSES OF SHOCK

CLASSES OF SHOCK Cariogenic Shock Hypovolemic Shock Distributive shock Obstructive shock

CLASSES OF SHOCK Cargiogenic Shock Hypovolemic Shock Distributive Shock Obstructive Shock

CLASSES OF SHOCK TRACARIDIAC HYPOVOLEMIC Obstruction IECARDIOGENc] DISTRIBUTIVE Decreased Fluidness. e. g. Pericardial Myocardia systemic hemorrhage tamponade Injuny or Reduced Reduced 「 Reduced performance Lo cardiac sfunction Decreased arteriA or nomal Maldistribution Multiple organ of blood flow in

CLASSES OF SHOCK

PATHOPHYSIOLOGY Compensatory Cellular Organ mechanism changes responses

PATHOPHYSIOLOGY Compensatory mechanism Cellular changes Organ responses

COMPENSATORY MECHANISM Right Heart Left Heart 5,000 ml/min 700 ml/min 700 mlmin 5.000 ml/min Corona 1,000 ml/min Kidney 4 mm Hg GI System L 1250 mvmi 104 mm Hg 1. 450 ml/min Skeletal 1. 450 ml min Muscle 375 ml/min 375 mlmin Skin

COMPENSATORY MECHANISM

COMPENSATORY MECHANISM Medulla Sympathetic neurons

COMPENSATORY MECHANISM