Multiprofessional Critical Care Review: Pediatric 2024 (MCCRCP24ON)-06

06_Shock Highlights

Pdf Summary

This document is a presentation on shock, covering its physiology, classification, and management. It is authored by Jerry J. Zimmerman from Seattle and includes disclosures of research funding and royalties. Shock involves a decrease in essential cellular substrates, with oxygen being a crucial substrate for life. Mitochondria play a key role in respiration, generating reducing equivalents and producing ATP. Lactic acidosis can result from various causes such as impaired oxygen delivery or glycolysis. Shock can be classified as hypovolemic, cardiogenic, or distributive. Treatment focuses on restoring normovolemia and optimizing cardiovascular performance to improve oxygen delivery. Oxygen delivery components include hemoglobin, cardiac muscle, and mitochondria. Fluid resuscitation aims to restore circulating volume, oxygen-carrying capacity, and correct metabolic imbalances. Vasoactive-inotropic interventions are context-dependent, impacting inotropy, afterload, and organ perfusion. Clinical clues of mitochondrial dysfunction include rising serum lactate despite adequate oxygen delivery. Treatment strategies for shock-related dysoxia target specific pathologies affecting the lung, erythron, heart, and mitochondria. The presentation emphasizes the importance of optimizing the cardiac environment and fluid responsiveness in managing shock.

Keywords

shock

physiology

classification

management

oxygen delivery

mitochondria

lactic acidosis

fluid resuscitation

vasoactive-inotropic

Jerry J. Zimmerman

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