Assessment and treatment of shock

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The prognosis for shock is variable, from good to grave, depending on the underlying cause and clinical stage. However, even patients presenting with dramatic clinical signs may respond well to appropriate treatment. This chapter provides the reader with the tools to determine and administer appropriate treatment in cases of shock.

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3.1 Components that determine delivery of oxygen. O = blood oxygen content; CO = cardiac output; DO = oxygen delivery; Hb = haemoglobin; HR = heart rate; O = arterial partial pressure of oxygen; O = arterial oxygen saturation; SV = stroke volume.
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3.4 The normal relationship between oxygen delivery (DO) and oxygen consumption (VO). When DO falls below the critical level (DO crit) anaerobic metabolism ensues, and VO becomes dependent on DO.
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3.11 Pulse pressure profiles. Assessing the height and width of the pulse together allows an estimation of pulse volume. (a) Normal palpable pulse pressure profile. (b) Hyperdynamic pulse (tall and narrow) as palpated in compensated hypovolaemia. (c) Weak pulse (short and narrow) as palpated in decompensated hypovolaemia.
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3.12 Assessment of mucous membrane colour in hypovolaemic distributive shock. (a) Hypovolaemia causes mucous membrane pallor with a prolonged capillary refill time (CRT). (b) Maldistribution of blood flow causes hyperaemic mucous membranes with a brisk CRT in distributive shock.
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