Only going out but not entering

Small A, micro A, posterior micro A, significant contraction of precapillary sphincter

Only in but not out

Characteristics: Blood stasis in capillaries Precapillary sphincter relaxes and posterior sphincter contracts

No entry or exit

Features: Hypercoagulable DIC Irreversible shock, damage to multiple organ functions

Protein breakdown; blood sugar rises

Early stage: respiratory alkali Late stage: pyruvate (P) → lactic acid (L) L/P increases Acidosis, oxygen dissociation curve shifts to the right Acidosis Hyperkalemia

Damage to pulmonary capillary endothelial cells and pulmonary epithelial cells Decreased surfactant: alveolar collapse or atelectasis ARDS can occur during the shock stage or 48-72 hours after shock stabilization - the main cause of death in shock

Effective circulating blood volume decreases, GFR decreases → cortical tubular necrosis → ARF, oliguria

Cerebral edema, high intracranial pressure → consciousness disorder, encephalopathy, coma

Decreased coronary blood flow and focal myocardial necrosis

Enterogenic infections → MODS, an important cause of death

The organ that rarely undergoes irreversible changes during shock is the liver.

Nervous, excited, irritable, pale, cold limbs, fast HR, small PP, oliguria; BP does not decrease

Apathetic and dull, pale skin, cold sweats, cyanosis of lips, slow pulse, progressive decrease in BP, oliguria or even anuria

mental state

skin temperature, color

blood pressure

shock index

pulse rate

urine output

Central venous pressure (CVP): most commonly used

arterial blood gas analysis

Arterial blood lactate measurement

DIC detection

Swan-Ganz floating catheter

Body position: Elevate head and trunk 20-30°, lower limbs 15-20° Establish intravenous access, inhale oxygen, and maintain warmth

crystalloid

Early stage: hyperventilation, respiratory alkalosis, oxygenation curve deviates to the left, and oxygen is not easily released Early use of alkaline drugs is not recommended Acidic environment: oxygen is easily released, relieving hypoxia Principles: use acid and alkali, improve perfusion, and use alkaline drugs in a timely manner

vasoconstrictor

vasodilators

cardiotonic pills

Heparin anticoagulation Low molecular weight dextran: expand blood volume

For septic shock and severe shock *Refractory shock with unsatisfactory blood pressure after routine anti-shock treatment: GC

Large blood vessels, liver and spleen rupture, gastroduodenal bleeding, portal hypertension variceal bleeding Rapid blood loss > 20% (1000ml) → hemorrhagic shock

Replenish blood volume

Stop bleeding

The relationship between CVP and fluid replacement P33

Unknown pathogen: empiric dosing - broad spectrum Abdominal infection (intestinal bacteria): carbapenems, third-generation cephalosporins, anti-anaerobic drugs When the pathogenic bacteria are clear: drug susceptibility results are used

Early, large amount, maintained for 48 hours Inhibit inflammatory response and stabilize lysosomal membrane Avoid serious complications such as acute gastric mucosal damage and immunosuppression