ACUTE CIRCULATORY DISTRESS
I.INTRODUCTION
- The circulatory system’s role is to provide the entire body with the oxygen it needs to function properly.
- Ensures blood circulation at a certain pressure.
- This pressure is necessary to oxygenate all the organs.
- To ensure this circulation, the 3 elements constituting the circulatory system must function correctly: CARDIAC PUMP, VESSELS, BLOOD.
II.DEFINITION
- ACUTE CIRCULATORY DISTRESS = SHOCK = Failure of the circulatory system. (pump, vessels or blood)
- Significant decrease in blood flow.
- Inability to ensure the supply of O2 to the body.
- Suffering of all organs in order of priority.
- VITAL risk in the very short term in the absence of treatment.
III. MECHANISMS
HEART PUMP:
Heart failure, inability to provide sufficient flow and pressure.
VESSELS:
General dilation of the arteries responsible for a drop in flow and pressure.
BLOOD:
Decrease in volume responsible for a drop in flow and pressure.
Failure of the heart pump or vessels or blood = suffering of the organs due to lack of o2
- But the NOBLE organs are protected for a certain time
Compensatory mechanism of the heart and brain: Peripheral vasoconstriction allows sufficient flow and pressure to be maintained towards the noble organs, hence:
- SKIN PALEUR
- MARBLING
- COLD SKIN
- DECREASED RENAL FILTRATION
- In the absence of treatment , rapid onset of suffering in the noble organs
= CARDIO-RESP ARRET
IV. CLINICAL SIGNS
- Heart rate > 100/min (< 40 if exhausted).
- Thready radial pulse.
- TA normal then LOW.
- Sweats.
- Pale, cold, mottled skin.
- Anxiety, agitation.
- Increased respiratory rate.
- Thirsty.
V.CAUSES
A) HEART PROBLEM = HEART SHOCK Heart failure, inability to provide sufficient flow and pressure
- Either by affecting the electrical activity of the heart
Frequency too FAST = TACHYCARDIA IF > 100
Frequency too SLOW = BRADYCARDIA IF < 60
Irregular rhythm = EXTRASYSTOLES, ARRHYTHMIAS,…
- Either by damage to the heart muscle (myocardium) = MYOCARDIAL INFARCTION
The heart muscle cells are no longer supplied with O2, so they will die
Loss of function of part of the muscle due to necrosis
Less efficient pump, risk of CIRCULATORY DISTRESS.
ACUTE CIRCULATORY DISTRESS
B) DECREASE IN BLOOD VOLUME = HYPOVOLEMIC SHOCK
Decrease in volume responsible for a drop in flow and pressure
Hemorrhage: loss of blood
Dehydration: loss of water
Severe burns: loss of plasma
C) VESSELS: SUDDEN AND GENERAL ARTERIAL DILATATION
Infection → septicemia →vasodilation →septic shock = FEVER, CHILLS + Signs OF SHOCK.
Allergy → urticaria → vasodilation → anaphylactic shock = ALLERGY, URTICARIA + Signs OF SHOCK (Basis of treatment = ADRENALINE +++ because VASOCONSTRICTOR medication) .
ACUTE CIRCULATORY DISTRESS
VI. CONDUCT TO BE ADOPTED
- Stretch out, possibly with lower limbs raised.
- Stop bleeding if necessary (gloves).
- Vital assessment (consciousness, ventilation (FR, skin), circulation (HR, BP, skin)).
- Circumstantial assessment (when?, where?, how?, history, treatment).
- Injury assessment (traumatic injuries).
- Oxygen therapy (inhalation, 9 to 15 l/min, high concentration mask).
- Cover and reassure.
- Alert and report to SAMU
- Monitoring of vital functions (circulatory +++)
The basics of treatment = Raise or maintain BLOOD PRESSURE (BP)
PA = HR x Blood volume x Vessel tone
1° PA+ FC CARDIOGENIC shock
2° PA+ VOLUME HYPOVOLEMIC shock HEMORRHAGIC shock
3° PA+ TONUS SEPTIC SHOCK ANAPHYLACTIC SHOCK
Wisdom teeth can be painful if they are misplaced.
Composite fillings are aesthetic and durable.
Bleeding gums can be a sign of gingivitis.
Orthodontic treatments correct misaligned teeth.
Dental implants provide a permanent solution for missing teeth.
Scaling removes tartar and prevents gum disease.
Good dental hygiene starts with brushing twice a day.