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Resuscitation and Shock PowerPoint Presentation

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Description : Check out this medical presentation on Emergency Medical Services (EMS), which is titled "Resuscitation and Shock", to know about the ABC’s of resuscitation in the ED, review available oxygen delivery devices and airway adjuncts, describe the pathophysiology of shock and its major subtypes, and know the basics of treatment of shock in the ED.

Tags : Emergency Medical Services, EMS, Resuscitation, Shock

Published on : Aug 06, 2021 | Views : 3984 | Downloads : 20

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Slide 1-

Resuscitation and Shock LSU Medical Student Clerkship, New Orleans, LA
Slide 2-

Goals Provide an introduction to the ABC’s of resuscitation in the ED Review available oxygen delivery devices and airway adjuncts Describe the pathophysiology of shock and its major subtypes Provide an introduction to the basics of treatment of shock in the ED
Slide 3-

Emergency Medicine Always Starts with the ABC’s A – Airway B - Breathing C - Circulation
Slide 4-

Airway Remove any obstructions Head tilt, chin lift Jaw Thrust Oropharyngeal and nasopharyngeal airways Orotracheal and nasotracheal intubation Cricothyroidotomy and Tracheotomy
Slide 5-

Rapid Sequence Intubation Assume every ED patient has a full stomach Combination of sedation and paralysis to facilitate procedure Evidence based to increase chance of success and decrease incidence of aspiration Not without its dangers: paralyzing a patient who cannot be ventilated
Slide 6-

Rapid Sequence Intubation Assume every ED patient has a full stomach Combination of sedation and paralysis to facilitate procedure Evidence based to increase chance of success and decrease incidence of aspiration Not without its dangers: paralyzing a patient who cannot be ventilated
Slide 7-

Three Indications for RSI Airway Protection Respiratory Failure Expected Clinical Course
Slide 8-

Breathing Hypoxic Respiratory Failure Hypercapnic Respiratory Failure Mechanical Respiratory Failure
Slide 9-

Oxygen Delivery Devices Nasal Cannula - up to 40% FiO2 Venturi mask - fixed 25% to 50% FiO2 Nonrebreather mask - theoretical 100% FiO2 Bag Valve Mask – 100%FiO2 Noninvasive Positive Pressure Ventilation (BiPAP or CPAP) FiO2 up to 100% based on setting
Slide 10-

Circulation Restoration of a pulse is the first goal ACLS However having a pulse is not the end of the story Adequate circulation requires correction of shock
Slide 11-

Shock Shock is defined as circulatory insufficiency that creates an imbalance between tissue oxygen supply and oxygen demand. The result of shock is global tissue hypoperfusion and is associated with a decreased venous oxygen content and metabolic acidosis (lactic acidosis).
Slide 12-

Pathophysiology of Shock Imbalance between tissue supply and demand  Anaerobic Metabolism  Lactic Acid Production
Slide 13-

Types of Shock Hypovolemic Cardiogenic Distributive Obstructive
Slide 14-

Hypovolemic Shock Caused by inadequate circulating volume (decreased preload) Hemorrhage (trauma, ruptured AAA, GI bleeding) Fluid loss (diarrhea, vomiting, poor intake, burns, third spacing)
Slide 15-

Cardiogenic Shock Caused by pump failure (decreased cardiac output) Myopathic – systolic dysfunction, diastolic dysfunction Arrythmic – disorganized cardiac activity
Slide 16-

Distributive Shock Caused by maldistribution of bloodflow from peripheral vasodilatation and decrease in SVR (decreased afterload) Sepsis Neurogenic Anaphylaxis Toxic shock syndrome
Slide 17-

Obstructive Shock Caused by extracardiac obstruction to blood flow Cardiac tamponade, tension pneumothorax, pulmonary embolus
Slide 18-

Clinical Presentation of Shock Clinical presentation varies with type of shock History and physical are key for determining underlying cause Hypotension is very common Lethargy, cool clammy skin, tachypnea, tachycardia, and cyanosis are common as well DIAGNOSE THE UNDERLYING CAUSE!!!!
Slide 19-

Treating Shock Early intervention is vital to reducing morbidity and mortality All efforts are aimed at balancing maximizing tissue oxygen supply decreasing tissue oxygen demand
Slide 20-

Treating Shock - Breathing Maximize oxygenation (Keep Sa02 > 93%) Control the work of breathing. Respiratory muscles are highly metabolic and can greatly increase oxygen demand.
Slide 21-

Treating Shock – Fluid Resuscitation Most patients in shock have either an absolute or relative volume deficit, except the patient in cardiogenic shock with pulmonary edema Central venous catheterization can guide help guide via central venous pressure monitoring and SVCO2 monitoring A bolus is a bolus!!
Slide 22-

Treating Shock – Vasopressors Vasopressor agents are used when there has been an inadequate response to volume resuscitation or when a patient has contraindications to volume infusion Vasopressors are most effective after fluid resuscitation but may be necessary to avoid prolonged hypotension Goal is generally a MAP of 65
Slide 23-

Treating Shock – Vasopressors
Slide 24-

Treating Shock – Endpoints No therapeutic end point is universally effective, and only a few have been tested in prospective trials, with mixed results. Table from Tintinalli
Slide 25-

Treating Shock – Endpoints
Slide 26-

Take Home Points The goal of resuscitation is to maximize survival and minimize morbidity using objective hemodynamic and physiologic values to guide therapy. The first few hours are vital. Diagnose and treat the underlying cause!!!