GEMC - Medical Student - Trauma - Shock

Project: Ghana Emergency Medicine Collaborative Document Title: Shock Author(s): Patrick Carter (University of Michigan), MD 2012 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/

We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, and adapt it. These lectures have been modified in the process of making a publicly shareable version. The citation key on the following slide provides information about how you may share and adapt this material. Copyright holders of content included in this material should contact open.michigan@umich.edu with any questions, corrections, or clarification regarding the use of content. For more information about how to cite these materials visit http://open.umich.edu/privacy-and-terms-use. Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questions about your medical condition. Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers.

!"

Attribution Key

for more information see: http://open.umich.edu/wiki/AttributionPolicy

Use + Share + Adapt

Make Your Own Assessment

Creative Commons – Attribution License

Creative Commons – Attribution Share Alike License

Creative Commons – Attribution Noncommercial License

Creative Commons – Attribution Noncommercial Share Alike License

GNU – Free Documentation License

Creative Commons – Zero Waiver

Public Domain – Ineligible: Works that are ineligible for copyright protection in the U.S. (17 USC § 102(b)) *laws in your jurisdiction may differ

Public Domain – Expired: Works that are no longer protected due to an expired copyright term.

Public Domain – Government: Works that are produced by the U.S. Government. (17 USC § 105)

Public Domain – Self Dedicated: Works that a copyright holder has dedicated to the public domain.

Fair Use: Use of works that is determined to be Fair consistent with the U.S. Copyright Act. (17 USC § 107) *laws in your jurisdiction may differ Our determination DOES NOT mean that all uses of this 3rd-party content are Fair Uses and we DO NOT guarantee that your use of the content is Fair. To use this content you should do your own independent analysis to determine whether or not your use will be Fair.

{ Content the copyright holder, author, or law permits you to use, share and adapt. }

{ Content Open.Michigan believes can be used, shared, and adapted because it is ineligible for copyright. }

{ Content Open.Michigan has used under a Fair Use determination. }

#"

$%&'()*'+"

•  ,-.(/"0'123).2"•  4.5678"9-:+3.8.;:"

•  97<-.=-:+3.8.;:"•  >8323(78"95'+'2<7).2"•  ?5'7<6'2<".@",-.(/"97)'2<+"

•  ?:='+".@",-.(/"

A"

,-.(/"0'123).2"

B  C27D'EF7<'".G:;'2"D'83*'5:"<."6''<"

6'<7%.83("D'672D+""

B  H'+F8<+"32";8.%78")++F'"-:=.='5@F+3.2"72D"6'<7%.83("7(3D.+3+"

B  ,-.(/"(72".((F5"I3<-"7"2.5678"%8..D"

=5'++F5'"72D"-:=.<'2+3.2"(72".((F5"I3<-.F<"

+-.(/"

J"

4.5678"9-:+3.8.;:"

K8..D"95'++F5'"L">$"M"9NH"

>$"O">75D37("$F<=F<"

9NH"O"9'53=-'578"N7+(F875"5'+3+<72('"

?3++F'"='5@F+3.2"3+"D53*'2"%:"%8..D"=5'++F5'"

P"

4.5678"9-:+3.8.;:"

>75D37("$F<=F<"L",N"M"QH"

"

?-F+R""

"

K8..D"95'++F5'"L",N"M"QH"M"9NH""

K8..D"95'++F5'"L",<5./'"N.8F6'"M"Q'75<"H7<'"M"9'53=-'578"N7+(F875"H'+3+<72('"

S"

!"#$%&'($)*+&'

4.5678"9-:+3.8.;:"

•  ,<5./'"N.8F6'"L"N.8F6'".@"%8..D"=F6='D"

%:"<-'"-'75<"DF532;"!"(75D37("(:(8'""

!"#$%&'($)*+&',-'.'/*012$0'$/'34."'/.1"$#-5'

67$1.#8,.)'9$0"#.12),"7'

:#&)$.8' ;<&#)$.8'

Kathy, clker.com

T"

,-.(/"97<-.=-:+3.8.;:"

U"

9-:+3.8.;3(">.6='2+7).2"

•  Q'75<"57<'"32(5'7+'+"7+"7"(.6='2+7<.5:"5'+=.2+'"<.",-.(/"

•  C27D'EF7<'"+:+<'63(".G:;'2"D'83*'5:"7()*7<'+"7F<.2.63("

5'+=.2+'+"<."6732<732"+:+<'63(".G:;'2"D'83*'5:"

–  ,:6=7<-')("2'5*.F+"+:+<'6"

•  4VR"'=32'=-532'R"D.=7632'R"72D"(.5)+.8"5'8'7+'"

–  >7F+'+"*7+.(.2+<53().2R"32(5'7+'"32"QHR"72D"32(5'7+'".@"(75D37("(.2<57()83<:"W(75D37(".F<=F<X"

–  H'232Y72;3.<'2+32"7G3+"•  Z7<'5"72D"+.D3F6"(.2+'5*7).2"72D"*7+.(.2+<53().2"

•  C2(5'7+'"32"%8..D"*.8F6'"72D"%8..D"=5'++F5'"

•  [.78"3+"<."6732<732"('5'%578"72D"(75D37("='5@F+3.2"

–  N7+.(.2+<53().2".@"+=872(-23(R"6F+(F8.+/'8'<78R"72D"5'278"

%8..D"\.I"

]"

^F8)Y.5;72"0:+@F2().2"

,:2D5.6'"W^$0,X"

•  C27%383<:".@"$#"<."6''<"6'<7%.83("D'672D+"

D'+=3<'"7_'6=<+"7<"=-:+3.8.;3(78"(.6='2+7).2"

8'7D+"<."<537D".@"87()("7(3D.+3+R"(75D3.*7+(F875"

32+F`(3'2(:"72D"32(5'7+'D"6'<7%.83("D'672D+"

•  0.I2I75D"+=3578"(.2)2F'+"I3<-"=5.;5'++3.2".@"=-:+3.8.;3("'a'(<+b"

–  >75D37("D'=5'++3.2"–  H'+=357<.5:"D3+<5'++"–  H'278"@738F5'"–  03++'6327<'D"C2<57*7+(F875">.7;F87).2"W0C>X"

•  H'+F8<"3+"'2D".5;72"@738F5'"72D"D'7<-""

!c"

>8323(78"95'+'2<7).2"

•  Q3+<.5:"–  H'('2<"3882'++"–  d'*'5"–  >-'+<"=732R",$K"–  e%D.63278"=732"

–  >.Y6.5%3D3)'+"

– ^'D3(7).2+"

–  ?.G32+fC2;'+).2+"–  H'('2<"-.+=3<783g7).2".5"+F5;'5:"

–  K7+'832'"6'2<78"+<7<F+"

•  9-:+3(78"'G76327).2"

–  N3<78",3;2+"–  >4,"O"6'2<78"+<7<F+"

–  ,/32"O"(.8.5R"<'6=R"

57+-'+R"+.5'+"

–  >N"O"hN0R"-'75<"+.F2D+"–  H'+="O"8F2;"+.F2D+R"HHR".G:;'2"+7<R"eK["

–  [C"O"7%D"=732R"53;3D3<:R";F75D32;R"5'%.F2D"

–  H'278"O"F532'".F<=F<"

!!"

037;2.+)("?..8+"

B  9-:+3(78"'G76""B  N,R"6'2<78"+<7<F+R"+/32"(.8.5R"<'6='57<F5'R"=F8+'+R"'<("

B  9),0,1.)'-,=0-'.08'-7+>"$+-'?.#7'8&>&08,0='$0'"4&'-&?&#,"7'$/'8,-&.-&'.08'&.#)7'#&1$=0,2$0',-'%&7'"$'8,.=0$-,-'.08',0"&#?&02$0'

B  C2@'().F+"+.F5('"B  K7+3("i7%+b"

B  >K>"B  >-'63+<53'+"

B  i7(<7<'"B  >.7;F87).2"+<FD3'+"B  >F8<F5'+"B  eK["

!#"

eDD3).278"037;2.+)("?..8+"

B  >?".@"-'7Df+32F+'+"@.5".((F8<"32@'().2+f7%+('++'+"

B  iF6%75"=F2(<F5'"@.5"6'232;3)+f'2('=-783)+"

B Z.F2D"(F8<F5'+""

B  e(F<'"7%D.63278"+'53'+"

B  e%D.63278f='8*3(">?".5"j,"

B  d3%532.;'2R"d09+R"0YD36'5"3@"+F+=3(3.2"@.5"0C>"

3+"-3;-"

!A"

C23)78"e==5.7(-"<."<-'"97)'2<"32",-.(/"

•  eK>+"– >75D3.5'+=357<.5:"6.23<.532;"

– 9F8+'"$G36'<5:"

– ,F==8'6'2<78".G:;'2""

– i75;'"%.5'"CN"7(('++"G"#"– eK[R"87%+"– d.8':"(7<-'<'5"– N3<78"+3;2+"32(8FD32;"5'(<78"<'6='57<F5'"

!J"

@A'

BA'

CA'

V+)67)2;"K8..D"95'++F5'"32"+-.(/"

=7)'2<+"

B  kF3(/"6'<-.D".@"'+)67)2;"

<-'"%8..D"=5'++F5'"32"

=7)'2<+"

B  C@":.F"=78=7<'"7"=F8+'"32"<-'+'"5';3.2+R"<-'2":.F"

/2.I"<-'",K9"3+"7<"8'7+<"<-3+"

2F6%'5b"

Anonymousgreek, Wikimedia Commons !P"

,-.(/"?5'7<6'2<"[.78+"

•  eK>0V"– e35I7:"– >.2<5.8"I.5/".@"K5'7<-32;"– $=)63g'">35(F87).2"

– eD'EF7<'".G:;'2"0'83*'5:"– ̂ .23<.5"V2D"=.32<+".@"5'+F+(3<7).2"

!S"

e35I7:"

•  e++'++"735I7:"=7<'2(:"72D"32<'5*'2'"32"(53)(788:"388"=7)'2<+"<."D'(5'7+'"I.5/".@"%5'7<-32;"72D"+F==.5<"

735I7:"(.2<5.8"

•  C2<F%7).2"72D"6'(-723(78"*'2)87).2"(72"323)788:"

I.5+'2"-:=.<'2+3.2"

–  ,'D7)*'+"@.5"H,C"(72"8.I'5"%8..D"=5'++F5'"–  9.+3)*'"=5'++F5'"*'2)87).2"D'(5'7+'+"=5'8.7D""

•  ^7:"2''D"7;;5'++3*'"*.8F6'"5'+F+(3<7).2"=53.5"<."

32<F%7).2"<."=5'*'2<"-'6.D:2763("(.887=+'"

!T"

K5'7<-32;"

•  H'+=357<.5:"57<'"32(5'7+'+"I3<-"+-.(/"<."(.6='2+7<'"@.5"6'<7%.83("7(3D.+3+"

•  H'+=357<.5:"6F+(8'+"(.2+F6'"7"+3;231(72<"

76.F2<".@".G:;'2""

•  ?7(-:=2'7"(72"@F5<-'5"'G7('5%7<'"87()("7(3D.+3+"

•  ^'(-723(78"*'2)87).2"72D"+'D7).2"I388"

D'(5'7+'"I.5/".@"%5'7<-32;"72D"36=5.*'"

.*'5788"+F5*3*78"

!U"

>35(F87).2"

•  C+.<.23("(5:+<788.3D+"W4.5678",7832'".5"

i7(<7<'D"H32;'5+X"3+".=)678"15+<Y832'"\F3D"

•  ?3<57<'"<.b"–  >N9"UY!#"66"Q;"3@":.F"-7*'"('2<578"*'2.F+"7(('++"

– ^732<732"F532'".F<=F<"clP"O"!lc"68f/;f-5"WAc"68f-5X""

–  C6=5.*'"-'75<"57<'"W[.78"QH"m"!ccX"

•  $n'2"5'EF35'+"875;'"76.F2<+".@"\F3D+".5"

%8..D"=5.DF(<+""WoJYS"i3<'5+X"

•  4."+F5*3*78".5"".F<(.6'"%'2'1<"@5.6"

(.88.3D+" !]"

$G:;'2"0'83*'5:"

•  0'(5'7+'".G:;'2"D'672D"@.5"=7)'2<+"

–  95.*3D'"7278;'+37"72D"72G3.8:)(+"<."5'87G"6F+(8'+"

– e*.3D"+-3*'532;"•  ^732<732"72D"32(5'7+'"75<'5378".G:;'2"+7<F57).2"

– [3*'"+F==8'6'2<78".G:;'2"

– ^732<732"-'6.;8.%32"o"!c";fDi"

•  ?3++F'".G:;'2"'G<57().2"(72"%'"6'7+F5'D"I3<-"

+'5378"87(<7<'"8'*'8+".2"72"eK[".5"('2<578"*'2.F+"

.G:;'2"+7<F57).2+"3@"'EF3=6'2<"3+"7*7387%8'"

#c"

H'+F+(3<7).2"V2DY9.32<+"

•  H'+F+(3<7).2";.78"3+"<."67G363g'"=7)'2<"+F5*3*78"

72D"632363g'"6.5%3D3<:"

•  j+'".%&'()*'"-'6.D:2763("72D"=-:+3.8.;3("

=7576'<'5+"<.";F3D'"+='(31("<-'57=:"

–  3l'l">-'(/"*3<78"+3;2+"72D"=-:+3.8.;3("675/'5+"

@5'EF'2<8:"

•  035'(<'D"=7576'<'5+"<."@.88.I"

–  j532'".F<=F<"o"clP"6if/;f-5"W+36=8'+<"6'7+F5'X"

–  >N9"UY!#"66Q;"W3@"('2<578"*'2.F+"7(('++"7*7387%8'X"

– ^e9"SP"<."]c"66Q;"

–  >'2<578"*'2.F+".G:;'2"(.2('2<57).2"o"Tcp"W3@"('2<578"*'2.F+"7(('++"7*7387%8'X"

#!"

Z-7<"3@"<-':"D.2q<";'<"%'_'5r"

B ,'75(-"@.5".<-'5"(7F+'+".@"='5+3+<'2<"-:=.<'2+3.2"32(8FD32;b""

B C27D'EF7<'"*.8F6'"5'+F+(3<7).2"

B $((F8<"%8''D32;"B 92'F6.<-.57G"

B >75D37("<76=.27D'"

B eD5'278"32+F`(3'2(:"

B e88'5;3("5'7().2"##"

?:='+".@",-.(/""

B Q:=.*.8'63(fQ'6.55-7;3("

B ,'=)("B >75D3.;'23(""B e27=-:87()("B 4'F5.;'23(""B $%+<5F()*'"

#A"

Q:=.*.8'63(",-.(/"

B  Q'6.55-7;3(""

B  ?57F67"

B  [C"K8''D"B  ^7++3*'"Q'6.=<:+3+"

B  eee"5F=<F5'"B  V(<.=3("=5';272(:".5"9.+<Y=75<F6"%8''D32;"

B  4.2Y-'6.55-7;3(""

B  N.63)2;f03755-'7"W[7+<5.'2<'53)+X"

B  ,6788"72D"i75;'"K.I'8".%+<5F().2"

B  972(5'7))+"B  KF52+""B  V2*35.26'2<78"W0'-:D57).2X"

"

#J"

>87++'+".@"Q:=.*.8'63(",-.(/"

CLASS I II III IV

BVL < 15% 15 - 30% 30 - 40% > 40%

AMOUNT 750 cc 750 - 1500 cc 1500 - 2000 cc > 2000 cc

PULSE <100 > 100 >120 >140

BP No change Narrowed pulse pressure

Consistent decrease in SBP

Decreased SBP and narrowed pulse pressure or no DBP

RESP No change 20-30 30-40 >35

CNS No change Anxiety Anxious, confused Confused. lethargic

Urine >30cc per hr 20-30cc per hr 5-15cc per hr negligible

TX Replace fluid loss

2L NS IV 2 L NS IV, usually requires blood transfusion

Rapid transfusion of blood and NS, requires immediate intervention to stop hemorrhage

#P"

Q:=.*.8'63(",-.(/"

B  eK>+R"CNf$#f^.23<.5"

B  V+<7%83+-"#"875;'"%.5'"CN+".5"7"('2<578"832'"B  >5:+<788.3D+"

B  4.5678",7832'".5"i7(<7<'"H32;'5+"

B  j="<."A"83<'5+"32"7DF8<+"B  9'D37<53(+"L"#c"((f/;"%.8F+'+"W67:"2''D"6F8)=8'"%.8F+'+X"

B  K8..D"95.DF(<+"WZ-.8'"K8..DR"9HK>q+fdd9f987<'8'<+X"

B  $"2';7)*'".5"(5.++"67<(-'D"3@"<:='"+='(31("3+"2.<"

7*7387%8'"

B  >.2<5.8"72:"+.F5('+".@"7()*'"%8''D32;"B  e5572;'"D'123)*'"32<'5*'2).2"@.5"-'6.55-7;3("

+-.(/"W$='57)2;"?-'7<5'X"

#S"

Q:=.*.8'63(",-.(/"

•  V*78F7<'"5'+=.2+'"<."<5'7<6'2<"

Rapid Response Transient Response

No Response

Vitals Return to normal Transient improvement with return to previous

Remain Abnormal

Estimated Blood loss

10-20% 20-40% with ongoing likely

Severe >40%

Need for more Fluid

Low High High

Need for Blood Type and cross Type specific O neg Need for surgery Possible Likely Highly likely

#T"

,CH,"

! ,:+<'63("C2\7667<.5:"H'+=.2+'",:2D5.6'"

W,CH,X"

–  0'12'D"%:"<-'"=5'+'2('".@"<I.".5"6.5'".@"<-'"

@.88.I32;b"

! K.D:"<'6="m"AS"s>"W]T"sdX".5"o"AU"s>"W!cc"sdX"

! Q'75<"H7<'"o"]c"%=6"

! HH"o"#c"%=6"

! ZK>"m"JRccc"('88+f66A".5"o"!#Rccc"('88+f66A".5"

;5'7<'5"<-72"!cp"%72D+"

#U"

,'=+3+"

B  ,'=+3+"L"0'12'D"7+",CH,"32"5'+=.2+'"<."7"(.2156'D"32@'().F+"=5.('++l""

B  ,'=)(",-.(/"L",'=+3+"=8F+"5'@57(<.5:"-:=.<'2+3.2"B  en'5"%.8F+".@"#cYJc"6ift;"=7)'2<"+)88"-7+".2'".@"<-'"

@.88.I32;b"

B ,K9"m"]c"66"Q;""

B ̂ e9"m"SP"66"Q;""

B 0'(5'7+'".@"Jc"66"Q;"@5.6"%7+'832'"""""""""""""

#]"

,'=+3+f,CH,"C2<'5@7('"

Ac"

4;F:'2"Q"'<"78l",'*'5'",'=+3+"72D",'=)(Y,-.(/b"H'*3'I".@"<-'"i3<'57<F5'"

72D"V6'5;'2(:"0'=75<6'2<"^727;'6'2<"[F3D'832'+l"e22"V6'5;"^'Dl"

#ccSuJ#b#UYPJl"

,'=+3+"97<-.=-:+3.8.;:"

A!"

,'=)(",-.(/"O">8323(78"

^723@'+<7).2+"B  >8323(78"@'7<F5'+b""

B Q:='5<-'5637".5"-:=.<-'5637"

B  ?7(-:(75D37"WQH"o"!ccX"B Z3D'"=F8+'"=5'++F5'"

B  i.I"+:+<.83("%8..D"=5'++F5'"W,K9m]cX"B ^'2<78"+<7<F+"(-72;'+"

B  ,.6'"=7)'2<+"67:"=5'+'2<"32"(.6='2+7<'D"

+-.(/"I3<-"7=='7572('".@"v2.5678w"%8..D"

=5'++F5'"

A#"

,'=)(",-.(/"Y"037;2.+3+"

B  >75D37("6.23<.5"

B  9F8+'"$G36'<5:"

B  i7%.57<.5:"?'+<+"B  >.6=8'<'"K8..D">.F2<"

B  >-'63+<5:"=72'8"W'8'(<5.8:<'+"72D"Kj4f>5'7)232'"

B  >.7;F87).2"=7576'<'5+"

B  i3*'5"@F2().2"<'+<+"B  i3=7+'"B  j53278:+3+"

B  eK["I3<-"87(<7<'"6'7+F5'6'2<"

B  >F8<F5'+b"K8..D"(F8<F5'"G"#R"F532'"(F8<F5'"B  >-'+<"GY57:"B  d.8':"(7<-'<'5"

AA"

,'=)(",-.(/"Y"?5'7<6'2<"

B  #"875;'"%.5'"CN+"B  4,"CNd"%.8F+Y"!Y#"i"I3D'".='2"W3@"2."(.2<5732D3(7).2+X""

B  ,F==8'6'2<78".G:;'2"

B  V6=353("72)%3.)(+"7+"+..2"7+"=.++3%8'"72D"%7+'D".2"

+F+='(<'D"+.F5('"B  ,F5*3*78"(.55'87<'+"I3<-"-.I"EF3(/8:"<-'"(.55'(<"72)%3.)("D5F;"3+"7D6323+<'5'D"

B  K5.7D"+='(<5F6"(.*'57;'"@.5"%.<-";576"=.+3)*'"72D"

;576"2';7)*'"%7(<'537"

B  9'5+3+<'2<"Q:=.<'2+3.2"?5'7<6'2<"

B  C@"2."5'+=.2+'"7n'5"#YA"i"CNdR"(.2+3D'5"+<75)2;"7"*7+.=5'++.5"W4.5'=32'=-532'R"0.=7632'R"'<(X"72D"

)<57<'"<."^e9"

B  [.78b""^e9"o"SP"

B  >.2+3D'5"7D5'278"32+F`(3'2(:b""Q:D5.(.5)+.2'"!cc"

6;"CN"

"

AJ"

V758:"[.78"035'(<'D"?-'57=:"

B  ,'=)(",-.(/"?5'7<6'2<"e8;.53<-6R"H3*'5+"'<"78l"4Vh^R"#cc!"B  ,<FD:"<-7<"'G7632'D"F+'".@"72"'758:";.78"D35'(<'D"<-'57=:"78;.53<-6"<."<5'7<"=7)'2<+"I3<-"+'=)("+-.(/"W7+"D'12'D"%:"5'@57(<.5:"-:=.<'2+3.2".5"87(<7<'"o"JX"

B  #SA"=7)'2<+"572D.68:"7++3;2'D"<."'3<-'5"<5'7<6'2<"756".5"<."+<72D75D"5'+F+(3<7).2"756+"W!Ac"*+l"!AAX"

B  >.2<5.8"756"<5'7<'D"I3<-"+<72D75D"(75'"72D"7D63_'D"<."C>j"

B  ?5'7<6'2<"756"@.88.I'D"=5.<.(.8"32"V0"@.5"S"-.F5+"72D"<-'2"7D63_'D"<."C>j"

B  d32D32;+f$F<(.6'"B  ?5'7<6'2<";5.F="5'('3*'D"6.5'"\F3D+"(.6=75'D"<."(.2<5.8";5.F="WP"i"*+l"AlP"iX"

B  AlU"D7:+"8'++"32"-.+=3<78"@.5"<5'7<6'2<";5.F="B  #"@.8D"8'++"(75D3.=F86.275:"(.6=83(7).2+"@.5"<5'7<6'2<";5.F="

B  D&).2?&'#&8*12$0',0'+$#".),"7'$/'EFGFH'AP"

V758:"[.78"035'(<'D"?-'57=:"

H3*'5+"V"'<"78l"V758:";.78YD35'(<'D"<-'57=:"32"<-'"<5'7<6'2<".@"+'*'5'"+'=+3+"72D"

+'=)("+-.(/"4"V2;8"h"^'Dl"#cc!bAJPb!ASUY!ATTl"

"

AS"

e27=-:87()(",-.(/"

B  e27=-:87G3+"B  ,'*'5'"+:+<'63("

-:='5+'2+3)*3<:"5'7().2"

B  >-757(<'53g'D"%:"6F8)+:+<'6"32*.8*'6'2<""

B  C;V"6'D37<'D"

B  e27=-:87(<.3D"5'7().2"B  >8323(788:"32D3+)2;F3+-7%8'"@5.6"727=-:87G3+"

B  0.'+"2.<"5'EF35'"7"+'2+3)g32;"'G=.+F5'"

B  4.<"C;V"6'D37<'D"

Justin Beck, Flickr

AT"

e27=-:87()(",-.(/"O">8323(78"

^723@'+<7).2+"

•  >8323(78",='(<5F6"–  d35+<",:6=<.6+b""

•  95F53<F+"•  d8F+-32;"•  j5)(7537"

–  95.;5'++3.2b""•  ?-5.7<"@F882'++"•  e2G3'<:"•  >-'+<");-<2'++"•  ,-.5<2'++".@"%5'7<-"•  i3;-<-'7D'D2'++"

–  ,'*'5'",:6=<.6+b"""•  e8<'5'D"6'2<78"+<7<F+"

•  H'+=357<.5:"D3+<5'++"•  >35(F87<.5:"(.887=+'"

•  H3+/"@7(<.5+"@.5"@7<78"727=-:87G3+""–  9..58:"(.2<5.88'D"7+<-67"""

–  95'*3.F+"727=-:87G3+"""

•  H'.((F55'2('"57<'+"–  JcYScp"@.5"32+'(<"+)2;+"–  #cYJcp"@.5"57D3.(.2<57+<"7;'2<+"

–  !cY#cp"@.5"='23(38832""

•  ^.+<"(.66.2"(7F+'+"–  e2)%3.)(+"–  C2+'(<+"–  d..D""

AU"

e27=-:87()(",-.(/"Y"037;2.+3+"

•  >8323(78"D37;2.+3+"–  0'12'D"%:"735I7:"(.6=5.63+'R"-:=.<'2+3.2R".5"

32*.8*'6'2<".@"(F<72'.F+R"5'+=357<.5:R".5"[C"+:+<'6+"

B  ^38DR"8.(783g'D"F5)(7537"(72"=5.;5'++"<."@F88"727=-:87G3+"

B  ,:6=<.6+"F+F788:"%';32"I3<-32"Sc"632F<'+".@"'G=.+F5'"

B  d7+<'5".2+'<".@"+:6=<.6+"L"6.5'"+'*'5'"5'7().2"

B  K3=-7+3("=5'+'2<7).2".((F5+"32"F="<."#cp".@"=7)'2<+"B  ,:6=<.6+"I388"5'<F52"AYJ"-.F5+"7n'5"323)78"5'7().2"-7+"(8'75'D"

•  i../"@.5"'G=.+F5'"<."D5F;R"@..DR".5"32+'(<"•  i7%+"-7*'"2."5.8'"

A]"

e27=-:87()(",-.(/"Y"?5'7<6'2<"

•  eK>q+"– H'+=357<.5:"(.6=5.63+'"5'EF35'"366'D37<'"

32<F%7).2"

•  CNR">75D37("^.23<.5R"9F8+'"$G36'<5:"

•  CNdq+R"$G:;'2"•  V=32'=-532'"@.5"e27=-:87G3+f,-.(/"•  ,'(.2D"832'"?-'57=3'+"

– >.5)(.+<'5.3D+"– Q!"72D"Q#"%8.(/'5+"

Jc"

e27=-:87()(",-.(/"Y"?5'7<6'2<"

•  V=32'=-532'"– clA"6;"C^".5",>".@"!b!ccc"D38F).2"@.5"727=-:87G3+""

– H'='7<"'*'5:"PY!c"632"7+"2''D'D"

– >7F).2"3@"=7)'2<".2"%'<7"%8.(/'5+"DF'"<."F2.==.+'D"78=-7"+)6F87).2"72D"5'+F8<72<"+'*'5'"

-:='5<'2+3.2"

– d.5">N"(.887=+'"W3l'l"(75D37("755'+<XR"!"6;"CN".@"

!b!cRccc"W+76'"7+"e>i,"0.+'X"

–  C@"5'@57(<.5:"-:=.<'2+3.2"72D"+-.(/R"+<75<"CN"D53="

J!"

e27=-:87()(",-.(/"Y"?5'7<6'2<"

•  >.5)(.+<'5.3D+"– ^'<-:8=5'D23+.8.2'"!#P"6;"CN""

–  95'D23+.2'"Sc"6;"9$"

•  e2)-3+<7632'+"

–  Q!"%8.(/'5Y"03=-'2-:D57632'"#PYPc"6;"CN"

–  Q#"%8.(/'5Y"H723)D32'"Pc"6;"CN"

•  K5.2(-.D387<.5+"–  e8%F<'5.8"2'%F83g'5"–  e<5.*'2<"2'%F83g'5"– ^7;2'+3F6"+F8@7<'"#";"CN".*'5"#c"632F<'+""

"

J#"

>75D3.;'23(",-.(/"

B  ^.5<783<:"=53.5"<."5'='5@F+3.2"

<-'57=:"L"PcYUcp"

B  ,3;2+b"B  >..8R"6._8'D"+/32"

B  ?7(-:=2'7"B  9F86.275:"*7+(F875"(.2;'+).2""

B  Q:=.<'2+3.2"B  e8<'5'D"6'2<78"+<7<F+"

B  4755.I'D"=F8+'"=5'++F5'"B  H78'+R"6F56F5"

B  0'12'D"7+b"B  ,K9"m"]c"66Q;"

B  >75D37("C2D'G"m"#l#"if6f6#"

B  9F86.275:">7=38875:"Z'D;'"

95'++F5'"W9>Z9X"o"!U"

66Q;"

Patrick J. Lynch, Wikimedia Commons JA"

>75D3.;'23(",-.(/""

•  >75D3.;'23(",-.(/"V).8.;:"– e(F<'"^:.(75D378"C2@75().2"We^CX"

– ,'=+3+"– ^:.(75D3)+"

– ^:.(75D378">.2<F+3.2"

– e(F<'"e.5)("C2+F`(3'2(:"

– e.5)(".@"^3<578",<'2.+3+"

– Q:='5<5.=-3(">75D3.6:.=7<-:"

JJ"

>75D3.;'23(",-.(/"

•  $n'2"5'+F8<+"@5.6"6:.(75D378"3+(-'637"

I3<-"8.++".@"8'n"*'2<53(F875"WiNX"@F2().2"

– >8323(78"+-.(/"'2+F'+"7n'5"8.++".@"Jcp"iN"•  H'+F8)2;"(75D37(".F<=F<"5'DF().2"8'7D+"<."87()("7(3D.+3+"72D"-:=.G37"

•  ,<5./'"*.8F6'"3+"5'DF('D""

– ?7(-:(75D37"D'*'8.=+"7+"(.6='2+7).2"@.5"

D'(5'7+'D",N"<."6732<732"(75D37(".F<=F<""

–  C+(-'637"72D"32@75().2"I.5+'2+"(5'7)2;"

D.I2I75D"+=3578"

JP"

>75D3.;'23(",-.(/"Y"037;2.+3+"

•  Vt["•  >MH"•  i7%.57<.5:b""

–  >.6=8'<'"K8..D">.F2<"

–  >-'63+<5:"972'8"WV8'(<5.8:<'+R"Kj4f>HX"

–  >75D37("'2g:6'+"W^:.;8.%32R">tR">tY^KR"?5.=.232X"

–  >.7;F87).2"+<FD3'+"•  V(-.(75D3.;576"

JS"

>75D3.;'23(",-.(/"Y"?5'7<6'2<"

•  ?5'7<6'2<"[.78+"

–  e35I7:"(.2<5.8"W3@"2'('++75:X"–  C6=5.*32;"6:.(75D378"=F6="@F2().2"

–  H'='5@F+3.2"W3@"7*7387%8'X"–  95'*'2)2;"@F5<-'5"6:.(75D378"D767;'"

•  ^.23<.532;""

–  >75D37("6.23<.5"

–  9F8+'"$G36'<5:"

•  ,F==8'6'2<78".G:;'2R"CN"7(('++"

•  C2<F%7).2"D'(5'7+'+"=5'8.7D"72D"(7F+'+"-:=.<'2+3.2"""

– ^7:"2''D"<.";3*'"\F3D"%.8F+"<."(.6='2+7<'"3@"32<F%7)2;"

JT"

>75D3.;'23(",-.(/"Y"?5'7<6'2<"

•  e^C"

–  e+=3532R"K'<7Y%8.(/'5R"^.5=-32'R"Q'=7532"

–  43<5.;8:('532"@.5"=732"(.2<5.8"W7*.3D"32"32@'53.5"^CX"

–  C@"2."=F86.275:"'D'67R"67:"<5:"CN"\F3D"@.5"K9"+F==.5<"

–  C@"=F86.275:"'D'67"

•  0.=7632'"O"I388"x"QH"72D"<-F+"(75D37("I.5/"

•  0.%F<7632'"O"^7:"D5.="%8..D"=5'++F5'"DF'"<."='53=-'578"

*7+.D387<7).2"

•  >.6%327).2"<-'57=:"67:"%'"6.5'"'a'()*'"

–  H'='5@F+3.2"?-'57=:"W3@",?V^C"72D"7*7387%8'"32"<-'"(8323(78"

+'y2;X"

•  >75D37("(7<-'<'53g7).2"I3<-"32<'5*'2).2""•  ?-5.6%.8:)(+"

"JU"

4'F5.;'23(",-.(/"

•  H'+F8<+"@5.6"+=3278"(.5D"32&F5:"I3<-"+-.(/"

87+)2;"@5.6"!YA"I''/+"

•  i.++".@"+:6=7<-')("<.2'"72D"5'+F8<72<"

F2.==.+'D"*7;78"<.2'"

•  0'(5'7+'D"*7+.6.<.5"<.2'""

•  H'+F8<+"32"-:=.<'2+3.2"72D"%57D:(75D37"

•  97)'2<+"67:"5'6732"78'5<R"I756R"72D"D5:"

D'+=3<'"<-'"-:=.<'2+3.2"

•  ,=3278"+-.(/"

–  ?'6=.575:"8.++".@"+=3278"5'\'G"7()*3<:"

%'8.I"7"<.<78".5"2'75"<.<78"+=3278"(.5D"

32&F5:"

–  4.<"<-'"+76'"7+"2'F5.;'23("+-.(/R"<-'"

<'56+"75'"2.<"32<'5(-72;'7%8'"

gunkyboy, Wikimedia Commons

J]"

4'F5.;'23(",-.(/Y"?5'7<6'2<"

•  eRKR>+"–  H'6'6%'5">Y+=32'"=5'(7F).2+"

–  Q3;-">Y+=32'"32&F53'+"5'EF35'"6'(-723(78"*'2)87).2""

•  >AY>JY>P"O"9-5'23("4'5*'"322'5*7).2"•  d8F3D"5'+F+(3<7).2"

–  t''="^e9"7<"UPY]c"66"Q;"@.5"15+<"T"D7:+"

–  ^32363g'"+'(.2D75:"(.5D"32&F5:"

–  C@"(5:+<788.3D"3+"32+F`(3'2<"F+'"*7+.=5'++.5+"

•  ,'75(-"@.5".<-'5"(7F+'+".@"-:=.<'2+3.2"–  $n'2R",>C"5'+F8<+"@5.6"<57F67"L"5f."Q'6.55-7;3(",-.(/"

•  d.5"%57D:(75D37"–  e<5.=32'"–  97('67/'5""

Pc"

$%+<5F()*'",-.(/"

•  ?'2+3.2"92'F6.<-.57G"

•  >75D37("?76=.27D'"

•  9F86.275:"V6%.83+6"

•  ,'*'5'"e.5)(",<'2.+3+"

P!"

$%+<5F()*'",-.(/"

B  ?'2+3.2"=2'F6.<-.57G"

B  e35"<57=='D"32"=8'F578"+=7('"I3<-"!"I7:"*78*'R"735f=5'++F5'"%F38D+"F="

B ^'D37+)2F6"+-3n'D"36='D32;"

*'2.F+"5'<F52"

B  >-'+<"=732R",$KR"D'(5'7+'D"%5'7<-"+.F2D+"

B  4."<'+<+"2''D'Df(8323(78"D37;2.+3+"B  ?5'7<6'2<b"4''D8'"D'(.6=5'++3.2"

@.88.I'D"%:"(-'+<"<F%'"Source: www.meddean.luc.edu/lumenMedEd/medicine/pulmonar/cxr/pneumo1.htm

Delldot, Wikimedia Commons

P#"

$%+<5F()*'",-.(/"

B  >75D37("<76=.27D'"

B  K8..D"32"='53(75D378"+7("=5'*'2<+"*'2.F+"5'<F52"<."72D"(.2<57().2".@"

-'75<"

B  V).8.;:b""?57F67R"9'53(75D3)+R"^C"

B  K'(/q+"<537Db""B Q:=.<'2+3.2R"6Fz'D"-'75<"+.F2D+R"hN0"

B  037;2.+3+b"i75;'"-'75<">MHR"'(-."B  ?5'7<6'2<b"9'53(75D3.('2<'+3+"

K8..D"

9'53(75D3F6"

V=3(75D3F6"

Aceofhearts1968, Wikimedia Commons

PA"

$%+<5F()*'",-.(/"

•  9F86.275:"'6%.83+6"

–  N35(-.I"<537Db""•  Q:='5(.7;F87%8'"•  N'2.F+"32&F5:"•  N'2.+<7+3+"

–  ,3;2+b""•  ?7(-:=2'7""•  ?7(-:(75D37"•  Q:=.G37"

–  i.I"53+/b"0YD36'5"

–  Q3;-'5"53+/b">?"(-'+<".5"Nk"+(72"

–  ?5'7<6'2<b""Q'=7532"

•  >.2+3D'5"<-5.6%.8:)(+"3@"+-.(/"

@5.6"9V"

Hellerhoff, Wikimedia Commons

PJ"

$%+<5F()*'",-.(/"

B  e.5)("+<'2.+3+"B  H'+3+<72('"<."+:+<.83("'&'().2"(7F+'+"D'(5'7+'D"(75D37("@F2().2"

B  >-'+<"=732"I3<-"+:2(.='"B  ,:+<.83("'&'().2"6F56F5"

B 0'123)*'"D37;2.+3+"I3<-"'(-."B N7+.D387<.5+"W4?[X"I388"D5.="=5'++F5'"B  ?5'7<6'2<b"e.5)("*78*'"+F5;'5:"

PP"

Z-3(-"=5'++.5"+-.F8D"C"(-..+'r"

! Q:=.*.8'63("+-.(/"

–  Fluids and Blood

! >75D3.;'23("+-.(/"–  Dobutamine - !1 agonist

! Increases squeeze and heart rate

! 4'F5.;'23("+-.(/"–  Fluids, phenylephrine, Levophed,

look for another type of shock if it is persistent

! e27=-:87()("+-.(/"–  Fluids and epinephrine

!  ,'=)("+-.(/"–  Neosynephrine - alpha agonist

! Increases SVR by arteriolar constriction

–  Norepinephrine/Levophed - alpha and beta agonists

! 0.=7632'"

–  Low Dose - increases renal blood supply

–  Medium Dose - beta effects (increases heart rate and squeeze)

–  High Dose - alpha effects (arteriolar constriction)

PS"

kF'+).2+r"

Dkscully, Flickr PT"