Core Content: Shock

This is core content - you GOTTA know it: SHOCK

There are two main ways that cell is able to generate ATP:

1. Oxidative phosphorylation: super efficient, requires oxygen

2. Substrate level phosphorylation: anaerobic; super inefficient, produces lactate --> only thing to do when you have local or systemic cellular hypoxia

There are two primary determinants of oxygen delivery (DO2): Cardiac Output, Arterial O2 Content

1. Arterial oxygen content (Arterial O2 sat + Hgb)

2. Cardiac output (HR x SV)

   • stroke volume determined by:

     • preload (how much blood is in the ventricle at the end of diastole)

     • afterload (or the force the heart has to pump against)

     • inotropy (how hard the heart is squeezing)

Shock is about oxygen delivery, not necessarily blood pressure.

There are four major categories of shock

• Distributive --> caused by vasodilation, pipe problem

  • Fluid responsiveness:

    • Core Content

    • Emcrit on Fluid Responsiveness

    • REBELEM on Fluid Responsiveness

• Cardiogenic --> bad heart. problem with the pump

• Obstructive --> most of the time issues with the RV; back-up of flow due to blockage in the pipes

• Case report via Circulation

• Hypovolemic --> not enough fluid. Pipes aren't filled

Shock index

HR/SBP. >0.9, helpful for the diagnosis of occult shock https://www.ncbi.nlm.nih.gov/pubmed/23599863/

Occult Causes of non-response to vasopressors

Don't just place CVL and forget about it. http://rebelem.com/occult-causes-of-non-response-to-vasopressors/

• Valuable tools:

  • POCUS

  • RUSH exam --> Rapid ultrasound in shock. Checking the pump, tank and pipes for causes of hypotension

    • Original RUSH Article

    • Emcrit on RUSH

RUSH Part I

RUSH Part II

Attribution

“Small Steps" by Lee Rosevere is licensed under CC BY-NC 4.0 / Song has been cropped in length from original form

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Cold Funk - Funkorama by Kevin MacLeod is licensed under a Creative Commons Attribution license (https://creativecommons.org/licenses/...)
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