1. The Many Faces of Shock Søren Boysen, DVM, DACVECC University of Montreal Saint Hyacinthe, Quebec, Canada Université de Montréal m m U

8. DO 2 = CO x CaO 2

9. DO 2 = CO x CaO 2 What factors influence cardiac output?

10. DO 2 = CO x CaO 2 Stroke volume Heart rate x

11. DO 2 = CO x CaO 2 Stroke volume - Preload - Aferload - Contractility Heart rate x

12. DO 2 = CO x CaO 2 What factors influence arterial oxygen content?

13. DO 2 = CO x CaO 2 CaO 2 = ( Hgb × 1.34 × SaO 2 ) + ( PaO 2 × .003) Hematocrit Hemoblobin saturation Arterial oxygen pressure

15. Inadequate Oxygen Delivery Delivery of blood to the tissues Vascular diseases (volume, tone) Oxygenation of blood Severe pulmonary disease Problems with hemoglobin (anemia, MetHgb) Cardiac disease (arythmia, contractility) Oxygen uptake/use by cells Mitochondrial dysfunction (sepsis, cyanosis)

27. Emergency Venous Cutdown

28. Emergency Venous Cutdown

29. Venous Jugular Cutdown

38. What is a Shock Dose of Fluids?

55. End Points of Resuscitation

60. Abdominal Counterpressure

61. Zola T 0 HR 186 bpm

62. Zola T10 HR 154 bpm Hypertonic Saline Hydromophone Recheck: Hct 28% TS 3.8 mg/dl, Lactate 7.1mmol /L ABP: 86 mmHg

63. Zola T10 HR 154 bpm Hypertonic Saline Hydromophone 30 ml/kg bolus LRS

64. Zola T10 HR 154 bpm Hypertonic Saline Hydromophone 30 ml/kg bolus LRS PCV 21% TS 2.4 mg/dL ABP 98 mmHg

65. Zola T10 HR 154 bpm Hypertonic Saline Hydromophone 30 ml/kg bolus LRS 2 units PRB’s

72. Estimating CVP

73. Estimating CVP

82. Questions?