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The patient with acute cardiovascular problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Obstructive shock occurs when there is impedance to the flow of blood through the central circulation. A number of conditions can cause obstructive shock, and treatment is focused on the correction of the disorder causing the obstruction.
Shock
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
Obstructive shock occurs when there is a physical obstruction to flow into, or out of, the heart. It is characterised by either impairment of diastolic filling (decreased preload) or excessive afterload or both. Impaired diastolic filling can result from direct venous obstruction, increased intrathoracic pressure or decreased cardiac compliance. In the context of the trauma patient, increased intrathoracic pressure can result from tension pneumothorax and pneumomediastinum. It can also result from mechanical ventilation where there is air trapping, excessive inflation pressures or excessive positive end-expiratory pressure. Cardiac tamponade is the commonest cause of restricted cardiac filling (compliance). Excessive afterload is more often associated with pulmonary embolism or aortic dissection. Obstructive shock, as with cardiogenic shock, may easily be missed in the trauma patient if there is co-existing evidence of hypovolaemia.
Shock and blood transfusion
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
In obstructive shock there is a reduction in preload due to mechanical obstruction of cardiac filling. Common causes of obstructive shock include cardiac tamponade, tension pneumothorax, massive pulmonary embolus or air embolus. In each case, there is reduced filling of the left and/or right sides of the heart leading to reduced preload and a fall in cardiac output.
Prevalence, clinical characteristics and outcomes of hypoxic hepatitis in critically ill patients
Published in Scandinavian Journal of Gastroenterology, 2022
Sigrún Jonsdottir, Margrét B. Arnardottir, Jóhannes A. Andresson, Helgi K. Bjornsson, Sigrun H. Lund, Einar S. Bjornsson
Shock was defined by persistent arterial hypotension leading to inadequate tissue perfusion with oliguria and poor peripheral perfusion in the clinical setting of hypovolemic (hypovolemic shock), sepsis (septic shock), cardiogenic events (cardiogenic shock) and extracardiac obstruction (obstructive shock). Heart failure was defined by a history of heart failure, clinical features or impaired left and/or right ventricular function on echocardiogram. Prolonged hypotension was defined as blood pressure <75 mmHg for 15 min or use of inotropes, massive fluid resuscitation, pericardiocentesis or intra-aortic balloon pump to sustain a higher blood pressure [9]. Cardiac arrest was defined as a sudden loss of blood flow due to failure of the heart to pump effectively [13]. Cardiac arrest can occur secondary to various disease states including cardiac arrhythmia, hypoxemia and decreased cardiac perfusion caused by cardiogenic, septic or hypovolemic shock. Cardiac arrest is a major etiology of HH and its cause can be difficult to determine. Therefore, cardiac arrest was categorized as a separate entity. Hypoxic respiratory failure was defined by a partial pressure of oxygen (PaO2) of <8.0 kPa (60 mmHg) in the appropriate clinical setting.
Echocardiography in a critical care unit: a contemporary review
Published in Expert Review of Cardiovascular Therapy, 2022
Muhammad Mohsin, Muhammad Umar Farooq, Waheed Akhtar, Waqar Mustafa, Tanzeel Ur Rehman, Jahanzeb Malik, Taimoor Zahid
Shock is considered a potentially life-threatening condition because it is a form of circulatory system failure causing inadequate oxygen delivery to the vital organs [1]. There are four types of pathological mechanisms underlying shock: (i) failure of pump function (cardiogenic shock), (ii) loss of vascular tone (septic or vasoplegic shock), (iii) obstruction to blood flow (obstructive shock), (iv) inadequate circulatory volume (hypovolemic shock) [2]. The mortality associated with shock ranges between 15% and 56% [3]. In view of the high risk of death, a prompt diagnosis of the type of shock with accurate underlying etiology is imperative for optimum management in critical care units (CCUs). Therefore, echocardiography can help in differentiating among various subsets of shock, identify the underlying pathology, and provide noninvasive monitoring during treatment of acute circulatory failure. Echocardiography is a readily available bedside investigative tool that offers a high diagnostic yield and exact etiology of the cardiac and hemodynamic compromise in a CCU. Hence, it is recommended as the first choice of investigation in consensus guidelines of intensive care medicine [4]. A rapid assessment by cardiac echo (RACE) should be performed immediately in a collapsed patient followed by a comprehensive echocardiographic assessment at a later time [5]. This review provides the basic etiology of different subtypes of shock and the contemporary use of echocardiography in its diagnosis and management.
Role of lung ultrasound in assessment of endpoint of fluid therapy in patients with hypovolemic shock
Published in Egyptian Journal of Anaesthesia, 2021
Ehab S. Abdalazeem, Ahmed G. Elgazzar, May E. M. A. Hammad, Rehab E. Elsawy
Exclusion criteria: Patients under 18 years, patients with obstructive shock, cardiogenic shock, and morbid obesity (body mass index above 50 kg/m2), suspected or diagnosed raised intra-abdominal or intrathoracic pressures as pregnancy, portal hypertension or mediastinal mass, intracerebral hemorrhage or increased intracranial pressure, valvular heart disease or atrial fibrillation.