Clinical Practice Guidelines of Shock

CLINICAL PRACTICE GUIDELINES OF SHOCK

  1. Definition : Shock is a life-threatening state that occurs when delivery of oxygen and nutrients to the tissues are insufficient to meet their relative metabolic demands.
  2. Objectives: To define MCH policy for optimal management of shock to prevent end-organ injury and to halt the progression to cardiopulmonary failure and cardiac arrest.
  3. Criteria :
  a) Clinical manifestations : Recognize signs of poor perfusion
  *  tachycardia, tachypnea, and signs of poor perfusion, including cool extremities, weak peripheral pulses, sluggish capillary refill
  * Hypotension or low BP: Minimum systolic BP by age: < 1mo: 60 mmHg; 1mo to 10y: 70 + (2 × age in years); ≥10y: 90 mmHg
  * Decreased mental status
  * Low urine output (<1 ml /kg/hour).
b) Etiology of Shock can result from –
  * Inadequate blood volume or inadequate oxygen carrying capacity – hypovolumic shock/ haemorrhagic shock.
  * Inappropriately distributed blood – distributive shock.
  * Impairment of cardiac contractility –cardiogenic shock.
  * Obstructed blood – obstructive shock.
C) Categorisation of shock by severity-   the severity of shock is frequently   characterized by its effect on systolic blood pressure.
—as long as compensatory mechanism is able to maintain systolic BP within normal range( i.e, defined as greater than 5th percentile systolic BP for age).
  * Compensated shock: is said if systolic BP is within normal range but signs of inadequate perfusion is present.
  * Hpotensive shock : is said if systolic hypotension and signs of inadequate tissue perfusion present. It is late sign of shock.
  * Warning Signs- i.e., progression of compensated shock to hypotensive shock include-1. marked tachycardia ,2. absent peripheral pulses and weakening central pulses, 3.cold distal extremities with very prolonged capillary refill, 4.narrowing pulse pressure, 5. Altered mental status and 6. Hypotension.

So early...