Shock neurogeno
Definizione
Lo shock neurogeno è dovuto a una perdita centrale del controllo vasomotore; ciò determina riduzione delle resistenze periferiche, ridistribuzione del volume plasmatico e diminuzione della pressione arteriosa. A causa dell’interessamento nervoso, l’inibizione dei meccanismi di vasocostrizione impedisce qualunque correzione dell’ipotensione.
Eziopatogenesi
Dal punto di vista eziopatogenetico lo shock neurogeno può essere causato da:
- Anestesia generale che può deprimere il centro vasomotore.
- Rachianestesia.
- Anestesia peridurale.
- Trauma cranico, in particolare della base con coinvolgimento del bulbo.
- Emorragia cerebrale.
- Disturbi metabolici, iperfemminili ipertermia.
- Intossicazioni: coma da barbiturici, sovradosaggio di oppiacei o di farmaci vasodilatatori, per esempio ganglioplegici o alfa-bloccanti.
- Ischemia e/o traumi midollari.
Articoli correlati:
Con il termine shock si intende una sindrome da insufficienza micro e macro-circolatoria acuta a patogenesi multifattoriale, ad evoluzione progressiva, solo inizialmente reversibile, caratterizzata da una perfusione tissutale inadeguata rispetto ai fabbisogni metabolici. E’ una sindrome pericolosa per la vita..
Lo shock cardiogeno è una condizione clinica caratterizzata da una riduzione della portata cardiaca ed ipossia tissutale in presenza di un adeguato volume ematico intravascolare dovuta a un deficit del miocardio o dell’apparato valvolare cardiaco. Lo shock cardiogeno si presenta con ipotensione (pressione arteriosa sistolica < 90 mmHg per almeno 30 minuti), riduzione dell’indice cardiaco ed elevata pressione capillare.La causa più frequente è l’infarto del miocardio. altre cause..(Continua a leggere)
Shock ostruttivo extra-cardiaco
Lo shock ostruttivo extra-cardiaco è causato da un ostacolo all’ efflusso di sangue dal ventricolo destro e/o sinistro con conseguente riduzione della perfusione sistemica, ipotensione e shock. Si tratta di una situazione in cui esiste un ostacolo alla circolazione del sangue nell’albero arterioso, mentre la funzione del miocardio stesso non è compromessa.
Tamponamento pericardico: la presenza di abbondante liquido..(Continua a leggere)
Lo shock ipovolemico è una condizione patologica caratterizzata da un deficit acuto del volume circolante che ha, come conseguenza, una inadeguata perfusione tissutale. Si manifesta clinicamente con tachicardia, ipotensione, estremità cianotiche e fredde, oligoanuria..(Continua a leggere)
Lo shock anafilattico è la reazione allergica, l’evento allergico più temuto e può portare anche all’exitus. Davanti ad una reazione anafilattica bisogna avere una certa prontezza di intervento e conoscere i sintomi e i segni per arrestare gli eventi che possono portare alla morte del paziente. Lo shock anafilattico si presenta in soggetti che sono sensibilizzati e che quindi presentano IgE nei confronti di un allergene. Si possono avere anche delle reazioni anafilattoidi che dal punto di vista clinico hanno..(Continua a leggere)
Rachianestesia nell’adulto (ostetrica esclusa)
Tecnica di anestesia che risale a oltre 120 anni, la rachianestesia (RA) ha conosciuto una nuova giovinezza negli ultimi decenni, come prova il numero di pubblicazioni recenti su questa tecnica. La sicurezza e la semplicità della RA, associate a una curva di apprendimento rapida, non consentono di minimizzarne i rischi. La conoscenza delle varianti anatomiche del paziente, gli aspetti tecnici, con una buona preparazione.. (Continua a leggere)
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