Understanding Hemodynamics in Cardiovascular Health
Delve into the intricate study of hemodynamics, exploring the interplay between pressure, resistance, and blood flow in the cardiovascular system. Discover the critical factors impacting blood circulation, from arterial pressure to venous return, and learn about hemodynamic emergencies like hypertension, shock, and more. Unravel the complexities of blood flow regulation, vessel resistance, and organ perfusion in both health and emergency situations.
Download Presentation
Please find below an Image/Link to download the presentation.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author. If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.
You are allowed to download the files provided on this website for personal or commercial use, subject to the condition that they are used lawfully. All files are the property of their respective owners.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.
E N D
Presentation Transcript
SULANTO SALEH-DANU R.,dr.,SpFK. DEPT. FARMAKOLOGI & TERAPI FAKULTAS KEDOKTERAN UGM FARMAKOLOGI : FARMAKOLOGI : DARAH & PERDARAHAN ( 3 ) DARAH & PERDARAHAN ( 3 ) HEMODYNAMIC & SHOCK HEMODYNAMIC & SHOCK
HAEMODYNAMIC and SHOCK 2
HEMODYNAMICS. Is the study of the relationship between PRESSURE, RESISTANCE and the FLOW of BLOOD in the cardiovasluar system. ( Aaronson, PI. & Ward J P T., 2000) Is the study of the movement of the blood and the forces concerned there in. ( Doorland s Illustrated Medical Dictionary, 27th ed., 1988). Hemodynamic, pertaining to the movements involved in the circulation of the blood. ( Doorland s Illustrated Medical Dictionary, 27th ed.,1988) 3
CO = (MABP-CVP)/ TPR CO = cardiac output, MABP = mean arterial blood pressure, TPR = total peripheral resistance, CVP = central venous pressure (copy from : Aaronson,PI., Ward,J.P.T., 1999) 4
AO = aorta Lg. arteries = large arteries Sm.arteries = small arteries ART = arterioles CAP = capillaries VEN = venule SV = venous Sm veins = small veins Lg veins = large veins 5
HEMODYNAMIC EMERGENCY PRESSURE : - hypertension - hypotension RESISTANCY : - obtruction of vessel - peripheral vasoconstriction - massive bleeding FLOW OF THE BLOOD : - blood viscocity - angina/O2 supply 6
HAEMODYNAMICS - Stroke / CVA - Vital organ damages. PRESSURE -Hypertension -Hypotension - Shock RESISTANCE -Vasoconstriction. -Obstruction Thrombus Emboli FLOW OF BLOOD -Scleroting of areteries Hematokrit -Increase of velocity BLOOD PRESSURE 7
HYPOTENSION SHOCK 8
BLOOD PRESSURE HYPOTENSION EMERGENCY ACTION SHOCK organs perfusion ORGANS / TISSUES DAMAGES 9
BLOOD FLOW ORGANS PERFUSION CRITICAL PERIODE REVERSEIBLE IRREVERSIBLE CELLULAR / TISSUE / ORGAN INJURY DEATH 10
Classification of shock by mechanism and common causes. Hypovolemic shock Cardiogenic shock Obstructive shock Distributive shock ( Messina, L.M., et al., 2003 ) 11
Distributive shock Cardiogenic shock Obstructive shock Hypovolemic shock Severe Decrease in Systemic Vascular resistance Reduced Ability to Fill ventricle In diastole Severe Myocardial depression Reduced Systolic performance Reduced preload Decrease in Stroke volume Maldistribution Of blood flow In microcircul. Hypotension Decrease in CO Severe decrease in Tissue & organ blood flow Multiple organ system failure ( Parrillo, JE., 1991 ) 12
Hypovolemic shock 1. Loss of blood (hemorrhagic shock) - External hemorrhagic : trauma, gastrointestinal bleeding, etc. - Internal hemorrhagic : hematoma, hemothorax, hemoperitoneum. 2. Loss of plasma : burns, exfoliative dermatitis. 3.Loss of fluid and electrolytes - External : vomiting, diarrhea, excessive sweating, hyperosmolar states (diabetic ketoacidosis, nonketotic coma) - Internal ( third spacing ) : Pancreatitis, Ascites, Bowel obstruction. 13
Cardiogenic shock - Dysrhythmia : - Tachyarrhythmia - Bradyarrhythmia - Pump failure : secondary to myocardial infarction or other cardiomyopathy. - Acute valvular dysfunction (especially regurgitant lesions ) - Rupture of ventricular septum or free ventricular wall 15
Obstructive shock - Tension pneumothorax - Pericardial diseases ( tamponade, constriction) - Diseases of pulmonary vasculature (massive pulmonary emboli, pulmonary hypertension) - Cardiac tumor ( atrial myxoma ) - Left atrial mural thrombus - Obstructive valvular diseases (aortic or mitral stenosis) 16
Distributive shock - Septic shock - Anaphylactic shock - Neurogenic shock - Vasodilator drugs - Acute adrenal insufficiency 17
TREATMENT and MANAGEMENT SHOCK 1. GENERAL MEASURE : ABC Advanced Cardiogenic Life Support (ACLS) Folley Catheter Laboratory : blood count electrolyt glucose blood gas analyse coagulation parameter blood group bacterial cultur VENTILATION Oxygen supply urinary output 2. CENTRAL VENOUS PRESSURE ( CVP ) or PULMONARY CAPILLARY WEDGE PRESSURE (PCWP) 18
3. VOLUME REPLACEMENT. I.V. LINE ( better use TRANFUSION SET ) HEMORRHAGIC SHOCK : BLOOD SUBSTITUTES / WHOLE BLOOD / PBRC (Packed Blood Red Cells) + isotonic solution preventing increase of Hmt. HYPOVOLEMIC SHOCK : Rapid bolus ISOTONIC CRISTALLOID CARDIOGENIC SHOCK : ISOTONIC CRISTALLOID ( smaller volume ) SEPTIC SHOCK : Large volume ISOTONIC CRISTALLOID. 1 L SHOCK in TRAUMA CAPITIS plus DEXTRAN. HYPERTONIC SALINE (7.5%) 19
4. MEDICATIONS 4.1. VASOACTIVE THERAPY : - AFTER ADEQUATE FLUID RESUSCITATION - DEPENDS ON CARDIAC OUTPUT Agents : - Dobutamine - Nor-adrenaline/Nor-epinephrine - Adrenaline/Epinephrine - Dopamine - Vasopressin ( antidiuretic hormon /ADH ) DISTRIBUTIVE/VASODILATOR SHOCK INOTROPIC agents VASOPRESSOR agents 4.2. CORTICOSTEROID 4.3. Activated Protein C and Anti-inflamatory ( 4.4. ANTIBIOTIC DEFINITIVE THERAPY in SEPTIC SHOCK 4.5. SODIUM BICARBONATE LACTIC ACIDOSIS SEPTIC SHOCK as antithrombotic, profibrinolytic SEPTIC SHOCK) SEPTIC SHOCK with 20
PRINCIPLES SHOCK MANAGEMENT : 1. ALLEVIATING THE PRECIPITATING CAUSE OF SHOCK; 2. TREATING THE HAEMODYNAMIC AND METABOLIC CONSEQUENCES; 3. MANAGING THE SECONDARY MEDICAL COMPLICATIONS ( renal failure; pulmonary oedema etc.) (Benowitz, N.L., et al., 1997) 21
