Principles Of Shock Management

Principles Of Shock Management

Describe management of a patient in state of shock.

Answer. Shock is defined as an acute clinical syndrome characterized by a significant, systemic reduction in tissue perfusion, resulting in decreased tissue oxygen delivery and insufficient removal of cellular metabolic products, resulting in tissue injury and severe dysfunction of vital organs.

State of Shock Management

• Treat the cause, e.g. arrest hemorrhage, drain pus.
• Fluid replacement: Plasma, normal saline, dextrose, Ringer’s lactate, plasma expander (haemaccel).
  Dosage is maximum l liter can be given in 24 hours. Initially crystalloids then colloids are given. Blood transfusion is done whenever required.
• Ionotropic agents: Dopamine, dobutamine, adrenaline infusions—mainly in distributive shock like septic shock.
• Correction of acid-base balance: Acidosis is corrected by using 8.4% sodium bicarbonate intravenously.
• Steroid is often lifesaving. 500–l000 mg of hydrocortisone can be given. It improves the perfusion, reduces the capillary leakage and systemic inflammatory effects.
• Antibiotics in patients with sepsis; proper control of blood sugar and ketosis in diabetic patients.
• Catheterization to measure urine output (30–50 mL/hour or > 0.5 ml/kg/hour should be maintained).
• Nasal oxygen to improve oxygenation or ventilator support with intensive care unit monitoring has to be done.
• Central venous pressure line to perfuse adequately and to monitor flid balance. Total parentral nutrition is given when required.
• Pulmonary capillary wedge pressure to monitor very critical patient.
• Hemodialysis may be necessary when kidneys are not functioning.
• Control pain-using morphine (4 mg IV).
• Ventilator and ICU/critical care management.
• Injectionranitidine IV or omeprazole IV or pantoprazole IV.
• Activated C protein even though costly is benefiial as it prevents the release and action of inflmmatory response.
• MAST(MilitaryAnti-shockTrouser)provides circumferential external pressure of 40 mm Hg. lt is wrapped around lower limbs and abdomen, and inflted with required pressure.
  It redistributes the existing blood and flid towards center. It should be deflted carefully and gradually.