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Obstructive Shock - PPTX 065320

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Shines Mariya
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54 views

Obstructive Shock - PPTX 065320

Uploaded by

Shines Mariya
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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OBSTRUCTIVE SHOCK

SHINES MARIYA SHAJI P


OBSTRUCTIVE SHOCK
• Impedence to either inflow or outflow of blood into or out of the heart
• It may be due to Cardiac Tamponade / Tension Pneumothorax
TENSION PNEUMOTHORAX
• During inspiration , air is pumped into the pleural cavity through a
valvular opening in the visceral pleura and underlying injured lung
• Lung collapses first and as air continously collects in the pleural cavity ,
mediastinum shifts towards the opposite side further decreasing the
volume of the functioning lung
• Increase in the pleural pressure
• Reduces the venous return , atrial filling and ventricular filling
• Reduces Cardiac Output and Cardiac Function
• It causes sudden death and hence emergency treatment is required.

• Within minutes to hours :


- The trachea shifts to the opposite side
- The lung on the same side collapses
- The lung on the opposite side is compressed to the chest wall and
cannot hyperinflate
- Cardiac compromise
CLINICAL FEATURES

• Tachypnoea
• Decreased cardiac output
• Tachycardia
• Decreased systolic BP
• Raised JVP
DIAGNOSIS

• Clinical diagnosis
• X- ray
• e- Fast : Bar code sign ,
Stratosphere sign , Loss of sea
shore sign
• Extended focused assessment
with sonography for trauma
(eFAST) is a non-invasive point-
of-care test, which can guide
clinical decision making.
Management of tension pneumothorax :

Emergency Management
• Needle thoracocentesis : insertion of wide bore needle to decompress the
tension pneumothorax
• In adults : 5th intercostal space , anterior to mid-axillary line
• In children : 2nd intercostal space in mid-clavicular line

Definitive Management
• Tube thoracocentesis : Insertion of intercostal tube (ICT) in the triangle of
safety
• Sucking wound covered with gauze and taped on three sides - reversal of
flow of one-way valve
• CHEST TUBES

- Inserted in triangle of safety


- Boundaries : Anterior axillary fold, Posterior axillary fold , Apex in axilla , Base -
5th intercostal space
- Connection : to an underwater seal bag to prevent air from re-entering
- Functioning : movement of column of fluid in water seal bag
- Position : Chest X-ray
-Removal: peak of inspiration , holding breath
Breath sounds are heard & Supporting Xray , Output : <100cc/24 hours
INDICATIONS
-Haemothorax , Hydrothorax, Chylothorax
-Pneumothorax ; Haemopneumothorax
-Empyema thoracis
-Traumatic lung contusion
-After thoracotomy , to drain pleural cavity

CONTRAINDICATIONS
-Traumatic diaphragmatic hernia
- Refractory coagulopathy
-Pleural adhesions
-Emphysematous bullae
COMPLICATIONS
- Clogging of ICT
- Innjury to intercostal nerve and vessels ,heart, liver , spleen
- Improper placement of tube
- Re-expansion pulmonary edema
CARDIAC TAMPONADE
• Rapid accumulation of fluid /blood in the pericardial space causing
increase in the intrapericardial pressure .
• 60-75 cc precipitate a tamponade
• Results in compression of cardiac chambers- Decrease venous return -
Decrease Cardiac Output

• CAUSES- Trauma , TB,Viral infectiobs


CLINICAL FEATURES

• Beck’s triad : Hypotension ,


Raised JVP/Distended neck
veins, Muffled heart sounds
• Pulsus Paradoxus
DIAGNOSIS

• Clinical diagnosis
• e-FAST : Hypoechoic collection
around heart
MANAGEMENT

Emergency Management
-Needle pericardiocentesis : Insertion of a needle in the sub-xiphoid space
at 45o angle to skin , directed to left shoulder tip

Definitive Management
- Emergency thoracotomy
THANK YOU

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