Cardiovascular Pathophysiology Pharmacology_ Treatment of Shock

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@Y Vbhroh`amacy-Vhtbapbyslamacy hed Trnhtonet ai  Pba`g

Znhdlec;  Hutaeaol` Enrvaus PystnoEatns 

@mlel`hm; n-Ondl`len hrtl`mnsPba`g, @hrdlacnel` 

Pba`g, Bypavamnol` 

Pba`g, Pnptl`

Vrnphrnd hed prnsnetnd jy;Ohr` Lobatnp @rhy, O.D.

JOP / @G-@P Tnh`bnr

bttp;//www.lobatnpvlrtuhmonds`b.`ao/ 

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:

Pba`g (`lr`umhtary) Niin`ts ai lehdnquhtn pnriuslae ae `nmm iue`tlae

@ml`g ta nxphed

Pnn; Pba`g (`lr`umhtary. pdi) 

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0

Pba`g, @lr`umhtary Dnilend

@lr`umhtary sba`g , `aooaemy geawe hs kust sba`g, ls hsnrlaus, mlin-tbrnhtnelec ondl`hm `aedltlae wbnrnlesuiil`lnet jmaad imaw rnh`bns jady tlssuns

 Hs jmaad `hrrlns axycne hed eutrlnets hraued jady,rndu`nd imaw blednrs dnmlvnry ai tbnsn `aopaenets tatlssuns, hed `he stap tlssuns irao iue`tlaelec prapnrmy

Tbn pra`nss ai jmaad netnrlec tlssuns ls `hmmnd pnriuslae,

sa wbne pnriuslae ls eat a``urrlec prapnrmy tbls ls `hmmnd hbypapnriuslaehm (bypa ? jnmaw) sthtn

Pba`g; He Avnrvlnw VDI jy Ol`bhnm M. @bnhtbho, OD, Nrenst I.K. Jma`g, OD,Bawhrd C. Poltb, OD, Kabe T. Vraons, OD, Purcl`hm @rltl`hm @hrn Pnrvl`n,Dnphrtonet ai Purcl`hm Ndu`htlae, Armheda Znclaehm Ondl`hm @netnr Armheda,

Imarldh

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4

Tbn prajmno le sba`g

 Hmtnrnd `lr`umhtary phrhontnrs 

@aopraolsnd ol`ra`lr`umhtlae 

Vnrslstnet snvnrn bypaxlh

Oumtlpmn arche ihlmurn

Irao; bttp;//www.`vpbhroh`amacy.`ao/`mlel`hm

tapl`s/bypatneslae.bto 

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>

Ohle typns ai Pba`g

 Yhsa`aestrl`tlvn

Trhuoh, jmnndlec, jurelec, lmnus (vamuone mass)

Vumoaehry nojamlso (lophlrnd `hrdlh` ilmmlec)

Oya`hrdlhm leihr`tlae (lophlrnd `hrdlh` `aetrh`tlae)

 Yhsadlmhthtlvn

 Hehpbymhxls, snpsls (ohmdlstrljutlae ai jmaad imaw)

Pplehm ondummhry lekury (vneaus paamlec)

Bypatbnrolh

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9

@mhsslil`htlae Le 8<3: Blesbhw hed @ax succnstnd

tbn iammawlec `mhsslil`htlae wbl`b ls

stlmm usnd tadhy Lt usns iaur typns ai sba`g; 

8. bypavamnol`,

:.  `hrdlacnel`,0. dlstrljutlvn hed

4. ajstru`tlvn sba`g

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3

@mhsslil`htlae(jhsnd ae `hrdlavhs`umhr `bhrh`tnrlstl`s, wbl`b whs

leltlhmmy prapasnd le 8<3: jy Blesbhw hed @ax)

Bypavamhnol`

Bnoarrbhcl`, Imuld

dnpmntlae, Le`rnhsndvhs`umhr `hph`lthe`n

@hrdlacnel`

Oyaphtbl`,On`bhel`hm, Hrrbytbol`

Dlstrljutlvn

Pnptl`, nt`.

Ajstru`tlvn

VN, pnrl`hrdltls,peuoatbarhx nt`.

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2

Bypavamnol` sba`gBypavamnol` sba`g  ‐   Tbls ls tbn oast `aooae typn ai sba`g hed

jhsnd ae lesuiil`lnet `lr`umhtlec vamuon. Lts prlohry `husn ls mass ai imuld irao tbn

`lr`umhtlae irao nltbnr he letnrehm ar nxtnrehmsaur`n.

 He letnrehm saur`n ohy jn bhnoarrbhcn.  Nxtnrehm `husns ohy le`mudn nxtneslvn

jmnndlec, blcb autput ilstumhn ar snvnrnjures.

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@hrdlacnel` sba`g@hrdlacnel` sba`g  ‐   Tbls typn ai sba`g ls `husnd jy tbn ihlmurn ai

tbn bnhrt ta puop niin`tlvnmy. Tbls `he jn dun ta dhohcn ta tbn bnhrt

ous`mn, oast aitne irao h mhrcn oya`hrdlhmleihr`tlae.

Atbnr `husns ai `hrdlacnel` sba`g le`mudn

hrrbytbolhs, `hrdlaoyaphtby, `aecnstlvnbnhrt ihlmurn (@BI), hed `hrdlh` vhmvnprajmnos.

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86

Dlstrljutlvn sba`g

Dlstrljutlvn sba`g ‐ 

   Hs le bypavamnol` sba`g tbnrn ls he lesuiil`lnet

letrhvhs`umhr vamuon ai jmaad

Tbls iaro ai "rnmhtlvn" bypavamnolh ls tbn

rnsumt ai dlmhtlae ai jmaad vnssnms wbl`bdlolelsbns systnol` vhs`umhr rnslsthe`nNxhopmns ai tbls iaro ai sba`g hrn;

8. Pnptl` sba`g  

:.  Hehpbymh`tl` sba`g  0. Enuracnel` sba`g  

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88

Ajstru`tlvn sba`g

Ajstru`tlvn sba`g  ‐   Le tbls sltuhtlae tbn imaw ai jmaad ls ajstru`tnd

wbl`b lopndns `lr`umhtlae hed `he rnsumt le

`lr`umhtary hrrnst.  Pnvnrhm `aedltlaes rnsumt le tbls iaro ai sba`g,

le`mudlec;8. @hrdlh` thopaehdn 

:. Tneslae penuoatbarhx 0. pumoaehry nojamlso 4.  Hartl` stneasls 

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8:

Neda`rlen sba`gZn`netmy h ilitb iaro ai sba`g bhs jnne letradu`nd;jhsnd ae neda`rlen dlsturjhe`ns. 

@husns; Bypatbyraldlso, le `rltl`hmmy lmm phtlnets, rndu`ns `hrdlh` autput

hed `he mnhd ta bypatneslae hed rnsplrhtary lesuiil`lne`y

Tbyrataxl`asls ohy ledu`n h rnvnrsljmn `hrdlaoyaphtby

 H`utn hdrnehm lesuiil`lne`y ls irnqunetmy tbn rnsumt aidls`aetleulec `artl`astnrald trnhtonet wltbaut thpnrlec tbndashcn

Bawnvnr, surcnry hed letnr`urrnet dlsnhsn le phtlnets ae`artl`astnrald tbnrhpy wltbaut hdkustlec tbn dashcn ta

h``aooadhtn iar le`rnhsnd rnqulrnonets ohy hmsa rnsumt le tbls`aedltlae

 Znmhtlvn hdrnehm lesuiil`lne`y le `rltl`hmmy lmm phtlnets wbnrnprnsnet baroaen mnvnms hrn lesuiil`lnet ta onnt tbn blcbnrdnoheds

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80

@aophrlsae ai typns ai sba`g(Nhrmy sthcn)

 Yhsa`aestrl`tlvn Yhsadlmhthtlvn

Bypavamhol` @hrdlacnel` @lr`umhtary Pnptl`

@hrdlh`

lednx

@hrdlh`lednx

Vnrlpbnrhmrnslsthe`n

Vnrlpbnrhm

rnslsthe`n

JmaadYamuon Jmaad Yamuon

Ohmpnriuslae hed arche dysiue`tlae hrn tbn umtlohtn ned palet ai hey sba`g sthcn

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84

Dn`rnhsnd `hrdlh` autput

 Dn`rnhsnd jmaad prnssurn

Dn`rnhsnd tlssun pnriuslae

Dn`rnhsnd `araehry pnriuslae

Dn`rnhsnd oya`hrdlhm iue`tlae

Ol`ra`lr`umhtary

ajstru`tlae

@nmmumhr hccrnchtlae

Ol`ra`lr`umhtary dnohcn

@nmm bypaxlh

Onthjaml`

h`ldasls

Dn`rnhsnd

oya`hrdlhm

`aetrh`tlae

Lerh`nmmumhrimuld

mass

Dn`rnhsnd

vneaus rnture

JV ? @A x PYZ

Vhtbapbyslamacy @ae`npt Ohp

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8>

Bypavamnol` Pba`g

mass le `lr`umhtary vamuon  

Dn`rnhsnd vneaus rnture

Dn`rnhsnd ilmmlec ai tbn `hrdlh` `bhojnrs

Dn`rnhsnd `hrdlh` autput

le`rnhsn le tbn systnol` vhs`umhr rnslsthe`n (PYZ).

maw `netrhm vneaus prnssurn (@YV), h maw pumoaehry `hplmmhry wndcn prnssurn (V@SV), maw

`hrdlh` autput (@A) hed `hrdlh` lednx (@L), hed blcb PYZ. Tbn hrtnrlhm jmaad prnssurn ohy jn

earohm ar maw.

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89

B\VAYAMNOL@ (amlcnol`)PBA@G

Bnoarrbhcl`

- Trhuoh

- Chstraletnstlehm

- Zntrapnrltaenhm

• Imuld dnpmntlae (eaebnoarrbhcl`)

Nxtnrehm imuld mass

Dnbydrhtlae

 Yaoltlec

Dlhrrbnh

Vamyurlh

Letnrstltlhm imuld rndlstrljutlae

Tbnrohm lekury

Trhuoh

 Hehpbymhxls

• Le`rnhsnd vhs`umhr`hph`lthe`n (vneadlmhthtlae)

- Pnpsls

- Hehpbymhxls

- Taxles/Drucs

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83

@hrdlacnel` Pba`g

dnpnednet ae paar puop iue`tlae

h`utn `hthstrapbl` ihlmurn ai mnitvnetrl`umhr puop iue`tlae

blcb V@SV, maw @A hed @L, hed cnenrhmmy h blcb PYZ

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82

@HZDLACNEL@

Oyaphtbl`

-Oya`hrdlhm leihr`tlae (Mnit

vnetrl`mn, Zlcbt vnetrl`mn)

-Oya`hrdlhm `aetuslae(trhuoh)

-Oya`hrdltls

-@hrdlaoyaphtby

-Vast ls`bnol`

oya`hrdlhm stueelec

-Pnptl` oya`hrdlhmdnprnsslae

-Vbhroh`amacl` Hetbrh`y`mlen`hrdlataxl`lty @hm`luo`bheenm jma`gnrs

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8<

On`bhel`hm

-Yhmvumhr ihlmurn Zncurclthet Ajstru`tlvn

-Bypnrtrapl` `hrdlaoyaphtby

-Ynetrl`umhr snpthm dnin`t

 Hrrbytbol`

-Jrhdy`hrdlh Pleus (n.c.,vhchmsye`apn)Htrlavnetrl`umhr jma`gs

-Th`by`hrdlh Puprhvnetrl`umhrYnetrl`umhr

@HZDLACNEL@ (:)

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:6

DLPTZLJ^TLYN

Pnptl` (jh`tnrlhm, iuechm, vlrhm, rl`gnttslhm)

Taxl` sba`g syedraon

 Hehpbymh`tl`, hehpbymh`tald

Enuracnel` (splehm sba`g)

Neda`rleamacl`

 Hdrnehm `rlsls

Taxl` (n.c., eltraprussldn, jrntymmluo)

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:8

Nxtrh`hrdlh` ajstru`tlvn sba`g  Lophlrnd dlhstaml` ilmmlec (dn`rnhsnd

vnetrl`umhr prnmahd) h pbysl`hm lophlronet ta hdnquhtn iarwhrd `lr`umhtary imaw levamvlec

on`bhelsos (dliinrnet tbhe prlohry oya`hrdlhm ar vhmvumhr dysiue`tlae )

Irheg dn`rnhsn le ilmmlec prnssurns (hs le ondlhstlehm `aoprnsslaes ai

crnht vnles) ar

trneds tawhrds nquhmlzhtlae ai prnssurns le tbn `hsn ai `hrdlh`thopaehdn ar

ohrgndmy le`rnhsnd rlcbt vnetrl`umhr ilmmlec prnssurns

Blcb @YV, maw V@SV @hrdlh` autput ls usuhmmy dn`rnhsnd wltb le`rnhsnd PYZ.

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::

Pyoptaos

Ehrrawlec aipumsn prnssurn

Th`by`hrdlh,bypatneslae

Znstmnssens

Dlspbarlh

Dn`rnhsnd urlenautput

 Hexlnty @aam, `mhooy sgle

Ajtuedhtlae

Dyspenh ^e`aes`lausenss

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:0

Trnhtonet aisba`g

Cnenrhmltlns;

Vasltlaelec, hvaldlec

bypatbnrolh Ohlethlelec hdnquhtn

axycnelzhtlae

Imuld rnsus`lthtlae

Vhle rnmlni 1

(leatrapl` trnhtonet1)

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:4

Nebhe`n `aopneshtary pbhsnai tbn sba`g

Ohletnehe`n ai onhe `lr`umhtary prnssurn 

Ohxlolzlec `hrdlh` iue`tlae

Zndlstrljutlec pnriuslae ta vlthm arches

Aptlolzlec uemahdlec ai axycne ht tlssuns

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:>

Ohlethle Yamuon

-Imuld rndlstrljutlae tavhs`umhr sph`n

Irao letnrstltluo(Pthrmlec niin`t)

Irao letrh`nmmumhrsph`n (Asoatl`niin`t)

-Dn`rnhsnd rnehm imuldmassns

Dn`rnhsndcmaonrumhr ilmtrhtlaerhtn (CIZ) Le`rnhsndhmdastnraen

Le`rnhsndvhsaprnssle

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:9

Olethle Vrnssurn

Dn`rnhsnd vneaus `hph`lthe`n

Le`rnhsnd syophtbntl` h`tlvlty

Le`rnhsnd `lr`umhtlec (hdrnehm) nplenpbrlen

Le`rnhsnd heclatnesle

Le`rnhsnd vhsaprnssle

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:3

Ohxlolzn @hrdlh` Vnriarohe`n

Le`rnhsnd `aetrh`tlmlty

Pyophtbntl` stloumhtlae Hdrnehm stloumhtlae

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:2

Nhrmy on`bhel`hm vnetlmhtlae

hmmaws jmaad imaw ta jn rndlstrljutnd

tneds ta rnvnrsn mh`tl` h`ldasls

supparts tbn phtlnet uetlm atbnr

tbnrhpnutl` onhsurns `he jn niin`tlvnTldhm vamuons le tbn ardnr ai 3-86 omgc-8 ai mnhe jady ohss, he A:

`ae`netrhtlae tbht rnsumts le hrtnrlhm shturhtlae eat mnss tbhe <:%, hdnquhtn

vnetlmhtar rhtn hed sndhtlae ta olelolzn tbn warg ai jrnhtblec.

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:<

Imuld rnsus`lthtlae

LY mlen

Mhrcn jarn `heeumh

Oarn lv mlen

@bal`n ai leiuslae

Mh`thtnd Zlecnr's

samutlae (leltlhmjamus; 86-:> om/gc / 86 ole.)

@ammalds

Dnxtrhen

Bydrantbymstrh`b Cnmhtlen

Pohmm vamuon rnsus`lthtlae

Zhtn, hoauet

Cnenrhm `aedltlaes

phrhontnrs ( JV, Vumsn,@YV, PhtA

: nt`)

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06

Dnxtrhen

Oamn`umhr wnlcbt; 46G - 96/36G Dhmtae

@ae`netrhtlae; 86% (46G)*7 9% (96/36G)**

Shtnr jledlec; :> om/c -- 4 - 9 b

Vmhsoh nxphedlec niin`t; * 826-:667 ** 8>6%

Nmlolehtlae;

onthjaml`

gldeny

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08

Bydraxyntbymstrh`b

Oamn`umhr wnlcbt; 4>6G - :66G - 46G Dhmtae

Pujstltutlae; 6,> - 6,9: - 6,3

Shtnr jledlec; 8> - :6 om/c -- 0 - 9 b

9% BNP (:66G/6,>) -- pmhsoh sujstltutlae (866%)

86%BNP (:66G/6,>) -- pmhsoh nxphedlec (846%)

Nmlolehtlae;

gldeny

8: - :4 b (9> - 36 %) --- 892 b

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0:

Leatrapl` drucs

Leatrapln Bnhrt rhtn PYZ Gldeny

Jmaad imaw

@arehrry

Jmaad imaw

@hrdlh`

Autput

Dasn

Nplenpbrle   ++ + + - + +  86-06

o`c/ole

 Earnplenpbrle   ++ 6 ++ -- + +   :-2o`c/ole

Daphole   ++ + - ++ + ++  :->o`c/ole/gc

Dajuthole   +++ (+) -- + + ++  >-8>o`c/ole/gc

Lsapratnrneam   ++ ++ - + + ++   > o`c/ol

Horleae   +++ 6 -- + + ++

Jamus 6.> -8.> oc/gc

@aet.; : ta

86o`c/gc/ole

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00

Iurtbnr Ptudy;

Kayet, Chvle (Hprlm :660). "Letradu`tlae taohehcnonet ai sba`g iar kuelar L@^ trhlenns hedondl`hm studnets". Tbn @blensn ^elvnrslty ai

Baec Gaec. Zntrlnvnd ae < A`tajnr, :684.