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（二）

Shock Shao mian Emergency Department, Zhongshan Hospital

Shao Mian Emergency Department，Zhongshan Hospital Shock

Causes of death in US 200000 400000 600000 disease of heart Malignant neoplasms Chronic lower respiratory diseases Cerebrovascular diseases accidents Alzheimer's disease Diabetes mellitus

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

definition Trauma Bood pressure Celluar injury Chemet

definition Trauma Bood pressure Celluar injury

definition The state in which Extreme Thirst/ Bluish Lips profound and Sale t Dry mouth widespread reduction of Rapid shallow Breathing effective tissure Chest perfusion leads first to eversible, if prolonged Cool 2E 2。 to irreversible cellular Clammy Pale skis下 Injury Skin

definition The state in which profound and widespread reduction of effective tissure perfusion leads first to reversible, if prolonged, to irreversible cellular injury

Pathophysiology Hemodynamic basis of shock Compensatory mechanism Organ dysfunction

Pathophysiology Hemodynamic basis of shock Compensatory mechanism Organ dysfunction

Hemodynamic Basis of Shock THE HEMODY NAMIC EQUATION BP (blood pressure) (cardiac output) (systemic vascular resistance CO stroke volume (Sv)x heart rate SV end diastolic volume(EDV)-end systolic volume(ESv) EDV= venous return + ESv

Hemodynamic Basis of Shock

Blood flow autoregulation E20 15 1.0 autoregulation 0.5 0 100 150 200 MEAN ARTERIAL PRESSURE [mm Hg]

Blood flow autoregulation

Cardiac output ↑ Cardiac Output CO=HRX SV ↑H.Rate ↑ Stroke Volume ↑s sympathetic Extrinsic Control Strength of Cardiac Contraction +(frank starling mechanism) Activity Intrinsic Control Epinephrine ↑ED Intrinsic Control +↑ Venous Return

Cardiac output

Preload Decreased compliance Norma Fluid compliance End diastolic volume

Preload