Sepsis, shock & MODS

50 Pages·2012·4.9 MB·English

by  Jozef Firment

Sepsis, shock
& MODS
Monika Grochova, MD, PhD.
Jozef Firment, MD, PhD.

Department of Anaesthesiology &
Intensive Care Medicine,
Medical faculty UPJŠ Košice
DEFINITION OF SHOCK
• Complex syndrom developped by
insufficient capillary nutritional
perfusion of tissues, insuficint delivery
of oxygen to the mitochondria
• Consequences: deficiency of oxygen &
energetical resources in tissues
= pathological metabolism
(anaerobic) & cummulation of toxic
tn
e
m
r
products. iF
2
SHOCK ACCORDING TO
PATOPHYSIOLOGY
• Hypovolemic
– (dehydration, haemorrhage)
• Distributive
– (spine laesion, high-level spinal
anaesthesia, anaphylactic, septic)
• Obstructive
– (pulmonary embolism, hydropericard,
pneumothorax)
• Cardiogenic tn
e
m
r
iF
– (AMI)
3
SHOCK ACCORDING
TO CLINICAL REASONS
• anaphylactic shock
( alergy to medicaments, to
venom, food, fruits )
• neurogenic shock  spinal shock (spinal cord
laesion, high spinal anaesthesia...)
• haemorrhagic shock
• traumatic shock
• burn shock
• toxic shock
(pancreatitis...)
• septic shock
(sepsis...)
tn
e
m
r
iF
• cardiogenic shock (AMI...)
4
DIFERENTIAL DG
Reason:
Saqual:
Anaphylactic response to allergen
• anafylactic
Loos of 20% circul. blood volume
• haemorrhagic
Traumat. laesion of cervical spine • neurogenic
Polytrauma • traumatic
• burn
Burns (>20%, >10% children,
>5% newborns and babies)
• toxic
Acute h.-necrot. pancreatitis
• septic
G- focus with bacteriaemia
tn
e
m
• cardiogenic r
iF
Large diaphragmatic MI
5
PREHOSPITAL PHASE –
FIRST SIGNS
Circulatory parameters:
• BP, P, circulatory centralisation, slow
capillary return, SpO , cold sweat vs hot
2
red skin
• restlessness-lethargy, shivering...

tn
e
m
r
iF
6
O supply
2
tn
e
m
r
iF
7
The oxygen delivery cascade indicating the
potential role of current and future therapies to
optimize oxygen delivery to the tissues
tn
e
m
r
iF
Rampal T, Jhanji S, Pearse R: Using oxygen delivery targets to optimize resuscitation in critically ill patients.
Current Opinion in Critical Care 2010, 16:244–249
8
s HYPOTENSION
n
g
i
s

k
c
o
h
S pulse rate
Shock index =
systolic BP

Interpretation:
belove 0,5 = normal find out
above 1,0 = treatment is needed

Cave! Digitalis, beta-blockers, cardiostimulators... tn
e
m
r
iF
10
OLIGURIA
s
n
g
i
s

k
Diuresis < 0,5 ml/kg/hour
c
o
h
S
LABORATORY SIGNS
MLAC > 2,5 mmol/l
tn
SvO2 > 70% or < 70% e
m
r
iF
11