Shock Veterinary Surgery

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Information about Shock Veterinary Surgery

Published on April 22, 2010

Author: adarshvet


SHOCK : SHOCK Dr. Adarsh Kumar Associate Professor DGCN COVAS, CSKHPKV, Palampur (India) & Faculty of Veterinary Medicine Al- Fateh University , Tripoli (Libya) Cells need two things to function 1. Oxygen 2. Glucose : Cells need two things to function 1. Oxygen 2. Glucose What is shock ? : What is shock ? Its the clinical state resulting from an inadequate supply of oxygen to the tissues or an inability of the tissues to properly use oxygen. The tissues in the body don't receive enough oxygen and nutrients to allow the cells to function. This ultimately leads to cellular death, progressing to organ failure and finally, to whole body failure and death. CAUSES OF SHOCK : CAUSES OF SHOCK Trauma : Trauma is the most common causes of shock in animals : e.g., fights with other animals, being struck by a car, and gunshots. Severe Haemorrhage : The blood in animals is 1/13th to 1/15th of its live body weight, if 25% of this total amount of blood is lost then severe haemorrhagic shock develops. Burns: Severe fluid loss Slide 5: Rough handling of viscera during surgery. Toxaemia : due to bacteria or other toxins. Bacterial infections : its also called bacterial / septic shock. Slide 6: Anaphylactic shock : certain drugs and foreign proteins. Other causes include poisoning, insect stings, fluid loss from vomiting and/or diarrhea, , and lack of oxygen caused by heart failure or obstruction of airways (pneumonia or choking, for example). Regardless of the cause, shock is life-threatening. Immediate identification is crucial What Causes Shock : What Causes Shock If cells are deprived of oxygen, instead of aerobic (with oxygen) metabolism, the cells use the anaerobic (without oxygen) pathway to produce energy. Unfortunately, lactic acid is formed as the by product of anaerobic metabolism. This acid changes the acid–base balance in the blood and leads to a downward spiral where cells start to leak toxic chemicals into the bloodstream Cause blood vessel walls to become damaged, and this process ultimately leads to the death of the cell. If enough cells die, then organs start to fail In the body, if the heart, blood vessels, or bloodstream (circulation) fail, then the body fails Where things go wrong : Where things go wrong The oxygen delivery system to the body's cells can fail in a variety of ways. The amount of oxygen in the air that is inhaled can be decreased. Examples include breathing at high altitude or carbon monoxide poisoning. The lung may be injured and not be able to transfer oxygen to the blood stream. Causes of this may include, among others: Pneumonia (an infection of the lung), Congestive heart failure where the lung fills with fluid Trauma with collapse or bruising of the lung. Where things go wrong : The heart may not be able to adequately pump the blood to the tissues of the body. Cases of this may include, among others: In the case of a heart attack, where muscle tissue is lost, or by a rhythm disturbance of the heart, when the heart can't beat in a coordinated way. It may also occur because of heart inflammation due to infection or other causes, again where the effective beating capabilities of the heart are lost. Where things go wrong Where things go wrong : There may not be enough red blood cells in the blood. If there aren't enough red blood cells (anemia), then not enough oxygen can be delivered to the tissues with each heart beat. Causes may include: Acute or chronic bleeding Inability of the bone marrow to make red blood cells The increased destruction of red blood cells by the body (an example includes sickle cell disease). Where things go wrong Where things go wrong : There may not be enough other fluids in the blood vessels. The blood stream contains the blood cells , plasma (which is more than 90% water), and many important proteins and chemicals. Loss of body water or dehydration can cause shock. The blood vessels may not be able to maintain enough pressure within their walls to allow blood to be pumped to the rest of the body. Normally, blood vessel walls have tension on them to allow blood to be pumped against gravity to areas above the level of the heart. This tension is under the control of the unconscious central nervous system, balanced between the action of two chemicals, adrenaline (epinephrine) and acetylcholine. If the adrenaline system fails, then the blood vessel walls dilate and blood pools bcoz of gravity . Since one of the steps in the cascade of events causing shock is damage to blood vessel walls, this loss of integrity can cause blood vessels to leak fluid, leading to dehydration which initiates a vicious circle of worsening shock. Where things go wrong Stages of Shock : Stages of Shock INITIAL STAGE Hypoperfusional state causes hypoxia Leading to the mitochondria being unable to produce adenosine triphosphate. Due to this lack of oxygen, the cell membranes become damaged and the cells perform anaerobic respiration. This causes a build-up of lactic and pyruvic acid which results in systemic metabolic acidosis. The process of removing these compounds from the cells by the liver requires oxygen, which is absent. So we find That in ------Early Stages of Shock : So we find That in ------Early Stages of Shock Bright red gums. Very rapid capillary refill time. The animal may be either excited or subdued. Rapid heart rate. Pulse not difficult to find. Slide 15: COMPENSATORY STAGE Middle Stages of Shock : Middle Stages of Shock Gums appear pale or "muddy". Abnormally long capillary refill time. The heart rate is frequently above normal. The pulse weakens and may be difficult to locate. The pet will most likely be subdued, depressed and weak. Respiration often shallow and rapid (but may be normal). Rectal temperature often below normal (may be normal or even elevated). Slide 17: PROGRESSIVE STAGE OF SHOCK Late Stages of Shock : Late Stages of Shock Gums extremely pale or show a bluish discoloration, and are often "blotchy" in appearance. Capillary refill time is longer (sometimes longer than 3 to 4 seconds). Heart rate is probably elevated and irregular, but may be normal or below normal as heart muscle begins to fail. The pulse will be very weak and difficult or impossible to locate. Respiration may be slow or rapid, shallow or deep. The eyes may take on a glazed appearance and appear not to focus normally. Mental condition deteriorates from depression to stupor to coma Slide 19: ENDOCRINE INFLUENCE IN SHOCK Types of Shock : Types of Shock 1) Hypovolemic shock: Due to loss of body fluids seen in trauma (haemorrhages), burns, vomition, diarrhea, intestinal obstruction etc. so there is either a) Blood loss b) Plasma loss c) Water loss Slide 22: 2) Cardiogenic Shock –It occurs due to failure of heart as pump or due to lowered cardiac output due to several causes. The circulatory failure is central in origin. Due to a) Myocardial infarction b) Arrhythmias c) Cardiac temponade d) Cardiac surgery e) Pulmonary embolism It is also seen in third degree burns when there is a production of myocardial depressant factor. Slide 23: 3) Vasogenic Shock: Shock characterized by peripheral pooling of blood due to: Loss of tone in resistance vessels as may happen in spinal anaesthesia. Trapping of blood in capacitance vessels as may happen in Endotoxic shock. Slide 24: 4) Septic shock: Due to failure of cells of vital organs to perform normal metabolism of oxygen e.g. in peritonitis, major burns. 5) Anaphylactic shock: Because of antigen-antibody reaction like penicillins, dextrans, serum injections. 6) Neurogenic shock: It follows serious interference with the balance of vasodilator and vasoconstrictor influences to both arterioles and venules. It is seen in clinical syncope, unpleasant event, hearing of bad tidings and sudden onset of severe pain. Slide 25: Air’s gotta go in and out. Blood’s gotta go round and round. Any variation of the above is not a good thing! Thanks and questions

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