Topics
1:-SHOCK
2:-Artificial respiration
3:-ASPHYXIA
SHOCK
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1. Definition
Shock is a life-threatening condition where there is inadequate blood circulation to vital organs → results in
oxygen deprivation, tissue hypoxia, and organ failure.
“Circulatory collapse with inadequate tissue perfusion.”
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2. Causes of Shock
Severe hemorrhage / trauma.
Extensive burns.
Severe infection / sepsis.
Myocardial infarction, heart failure.
Severe allergic reaction (anaphylaxis).
Spinal cord injury.
Poisoning, dehydration, vomiting, diarrhea.
Snake bite, electric shock.
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3. Types of Shock
A. According to Cause
1. Hypovolemic Shock
Due to severe blood loss, plasma loss (burns), fluid loss (vomiting, diarrhea).
Most common type.
2. Cardiogenic Shock
Due to failure of heart pump (MI, arrhythmia, heart failure, tamponade).
3. Distributive Shock (Vasodilatory)
Septic Shock → severe infection (endotoxins).
Anaphylactic Shock → allergic reaction (bee sting, drug).
Neurogenic Shock → spinal cord injury, brain injury, anesthesia.
4. Obstructive Shock
Due to obstruction to blood flow (pulmonary embolism, cardiac tamponade, tension pneumothorax).
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4. Pathophysiology
↓ Circulating volume / pump failure / vasodilation → ↓ cardiac output → ↓ tissue perfusion → tissue hypoxia
→ anaerobic metabolism → lactic acidosis → cell death → organ failure → death.
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5. Stages of Shock
1. Initial stage
↓ Perfusion, anaerobic metabolism begins.
2. Compensatory stage
Body maintains BP via tachycardia, vasoconstriction.
3. Progressive stage
Hypotension, worsening hypoxia, acidosis.
4. Irreversible stage
Multi-organ failure, death inevitable.
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6. Clinical Features
General Signs:
Restlessness, anxiety, weakness.
Rapid weak pulse (thready).
Low BP (systolic < 90 mmHg).
Rapid, shallow breathing.
Cold, clammy, pale skin.
Sweating.
Thirst, nausea, vomiting.
Reduced urine output (oliguria).
Altered consciousness.
Specific Signs:
Hypovolemic shock → tachycardia, weak pulse, cold extremities.
Cardiogenic shock → chest pain, pulmonary edema, cyanosis.
Septic shock → high fever, warm skin early → cold skin later.
Anaphylactic shock → urticaria, swelling face/larynx, bronchospasm, wheezing.
Neurogenic shock → hypotension, bradycardia, warm dry skin.
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7. First Aid in Shock
1. Lay patient flat (supine).
2. Elevate legs (unless fracture suspected).
3. Keep warm with blankets.
4. Loosen tight clothing.
5. Reassure patient, keep calm.
6. Control external bleeding if present.
7. Do not give food or drink (risk of aspiration).
8. Call for medical help immediately.
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8. Hospital Management
Oxygen therapy.
IV fluids (normal saline, Ringer’s lactate, plasma expanders).
Blood transfusion if hemorrhagic shock.
Vasopressors (dopamine, noradrenaline) if BP unresponsive.
Antibiotics for septic shock.
Adrenaline (IM) for anaphylactic shock.
Treat underlying cause (e.g., surgery for internal bleeding, stent for MI).
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9. Complications
Acute renal failure.
Respiratory failure (ARDS).
Disseminated intravascular coagulation (DIC).
Multi-organ failure.
Death.
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10. High-Yield MCQ Facts
Shock definition → circulatory failure with inadequate tissue perfusion.
Most common type → hypovolemic shock.
Early sign of shock → tachycardia.
Late sign → hypotension.
Pulse in shock → rapid, weak, thready.
Skin in hypovolemic shock → cold, clammy, pale.
Skin in septic shock (early) → warm, flushed.
Skin in neurogenic shock → warm, dry.
Anaphylactic shock treatment → adrenaline IM (0.5 mg, 1:1000).
Site for pulse check in shock → carotid (central pulse).
Urine output in shock → <30 ml/hr (oliguria).
Tourniquet use → last resort in hemorrhagic shock.
Compensatory mechanism in shock → tachycardia, vasoconstriction.
Irreversible shock → multi-organ failure.
Position in shock → supine, legs elevated.
Do not give → oral fluids to unconscious patient.
Main danger of hemorrhagic shock → death due to circulatory collapse.
Capillary refill test > 2 sec → indicates poor perfusion.
Mean arterial pressure (MAP) required for organ perfusion → ≥ 60 mmHg
2:-ARTIFICIAL RESPIRATION (Artificial Ventilation)
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1. Definition
Artificial respiration = the process of causing air to enter and leave the lungs of a person who has stopped
breathing (respiratory arrest) by manual or mechanical means, until normal breathing is restored or medical
help arrives.
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2. Indications (When Artificial Respiration is Needed)
Respiratory arrest due to:
Drowning
Electric shock
Asphyxia (suffocation, hanging)
Poisoning, gas inhalation (CO, CO₂)
Cardiac arrest (as part of CPR)
Trauma, head injury
Anesthesia complications
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3. Contraindications
Irreversible death (rigor mortis, decomposition).
Severe facial injury preventing mouth-to-mouth (→ use bag-mask instead).
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4. General Principles
Maintain airway → remove obstruction (vomit, foreign body, dentures).
Ensure rescuer safety (avoid toxic environment).
Position → patient supine, airway open (head-tilt chin-lift or jaw-thrust).
Rate: 10–12 breaths/min (adult), 20/min (children), 25–30/min (infants).
Each breath: 1 sec, just enough to make chest rise.
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5. Methods of Artificial Respiration
A. Manual Methods (Older / First Aid Techniques)
Used when no equipment available.
1. Mouth-to-Mouth Method (Most Effective, Standard First Aid Method)
Patient supine → head tilt–chin lift.
Pinch nose, seal rescuer’s mouth over patient’s mouth.
Blow air for 1 sec, chest should rise.
Give 2 breaths, then 30:2 with chest compressions (if no pulse).
Advantages: Simple, effective, immediate.
Disadvantage: Risk of infection, rescuer reluctance.
2. Mouth-to-Nose Method
If mouth injured or cannot open.
Rescuer’s mouth covers patient’s nose, patient’s mouth kept closed.
3. Sylvester’s Method (Arm-lift Chest-pressure Method)
Patient supine.
Rescuer kneels behind head.
Holds patient’s arms → pulls upward (inspiration), presses arms against chest (expiration).
12–16 times/min.
Not effective in spinal injuries.
4. Holger-Nielsen Method (Back-pressure Arm-lift Method)
Patient prone, head to one side.
Rescuer kneels at patient’s head.
Hands on back → press down (expiration), lift arms upward (inspiration).
Used in military training, swimming pools.
5. Shafer’s Method (Prone Pressure Method)
Patient prone, head turned sideways.
Rescuer kneels at patient’s hips.
Presses lower ribs/back → expiration, release → inspiration.
Useful in drowning cases.
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B. Mechanical Methods (Modern Medical Techniques)
1. Bag-Valve-Mask (Ambu Bag)
Self-inflating bag with mask.
Squeezed to deliver breaths.
Can be connected to oxygen supply.
Most widely used in hospitals/ambulance.
2. Ventilators (Mechanical Ventilation)
Used in ICUs.
Positive pressure ventilation via endotracheal tube/tracheostomy.
Types: Volume-controlled, Pressure-controlled.
3. Resuscitators (e.g., Pulmotor, Oxylog).
Portable machines delivering controlled breaths.
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6. Special Situations
Drowning → Clear airway first (remove water/vomit), start rescue breathing immediately (preferably mouth-
to-mouth).
Electric Shock → Ensure rescuer safety first, then artificial respiration + cardiac massage.
Choking → Heimlich maneuver first, then artificial respiration if needed.
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7. Complications
Gastric inflation (risk of vomiting, aspiration).
Rib fractures (in manual methods with pressure).
Transmission of infections (mouth-to-mouth).
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8. MCQ High-Yield One-Liners
Best method of artificial respiration in first aid → Mouth-to-mouth.
Best method in hospital → Bag-valve-mask with oxygen.
Sylvester’s method → Arm-lift, chest-pressure (supine position).
Holger-Nielsen method → Back-pressure, arm-lift (prone position).
Shafer’s method → Prone pressure (rescuer presses on back).
Artificial respiration rate (adults) → 10–12 breaths/min.
Children rate → 20/min.
Infants rate → 25–30/min.
First step before artificial respiration → Clear airway, ensure patency.
Position in Shafer’s method → Prone.
Position in Sylvester’s method → Supine.
Airway opening technique in unconscious patient → Head tilt–chin lift (unless spinal injury).
Airway opening if cervical spine injury suspected → Jaw thrust maneuver.
Gastric distension complication → due to excessive ventilation.
Bag-va
lve-mask → most effective emergency resuscitation device.
Mouth-to-nose is done when → mouth injured, cannot open.
Artificial respiration should be continued until → spontaneous breathing starts or medical help arrives.
3:-ASPHYXIA
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1. Definition
Asphyxia = condition in which the body (especially brain) does not get enough oxygen due to interference
with breathing or obstruction of air passage, leading to unconsciousness and possibly death.
It is essentially oxygen deficiency (hypoxia) + excess carbon dioxide (hypercapnia).
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2. Causes of Asphyxia
A. Obstruction of Airway
Foreign body (choking by food, dentures)
Strangulation, hanging, throttling
Swelling of airway (anaphylaxis, burns, infection)
B. Respiratory Causes
Bronchial asthma attack
Chronic obstructive pulmonary disease (COPD)
Pulmonary edema, pneumonia
C. Environmental Causes
Drowning
Poisonous gases → CO, CO₂, H₂S, methane, smoke inhalation
Oxygen-deficient atmosphere (mines, closed spaces)
D. Other Causes
Electric shock
Severe chest injury (crushed chest)
Drug overdose (narcotics, sedatives)
Neurological paralysis of respiratory center (brain injury, stroke)
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3. Pathophysiology
Lack of oxygen → failure of cellular metabolism.
Excess CO₂ accumulates → respiratory acidosis.
Leads to unconsciousness → cardiac arrest → death within 4–6 minutes if not treated.
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4. Signs and Symptoms
(Important for MCQs)
Early signs:
Restlessness, anxiety
Rapid breathing (dyspnea)
Difficulty in speech
Cyanosis (bluish discoloration of lips, nails, tongue)
Sweating, tachycardia
Late signs:
Dilated pupils
Convulsions, unconsciousness
Weak pulse, slow/irregular respiration
Death if not treated
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5. Post-mortem (Forensic importance – sometimes asked)
Congested face, petechial hemorrhages (conjunctiva), swollen lips/tongue.
Dark, fluid blood in right side of heart.
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6. First Aid and Management
1. Ensure rescuer’s safety (toxic gases, fire, water).
2. Remove cause immediately:
Choking → Heimlich maneuver.
Drowning → remove from water, clear airway.
Fire/smoke → shift to fresh air.
Hanging/strangulation → cut down rope, loosen clothing.
3. Maintain Airway:
Clear mouth and throat (foreign body, mucus, vomit).
Head-tilt chin-lift / jaw thrust.
4. Start Artificial Respiration (Mouth-to-mouth or bag-valve-mask).
5. If no pulse → Start CPR (Cardio-pulmonary resuscitation, 30:2 compressions to breaths).
6. Oxygen therapy if available.
7. Shift to hospital for further management (ventilator, antidotes, advanced care).
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7. Complications (if survives)
Brain damage (hypoxic encephalopathy).
Pulmonary complications (edema, pneumonia).
Cardiac arrhythmias.
Death if untreated.
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8. MCQ High-Yield Points
Asphyxia means → lack of oxygen + excess CO₂.
Most common cause in adults → choking by food/foreign body.
Time to irreversible brain damage in asphyxia → 4–6 minutes.
Earliest sign of asphyxia → restlessness.
Most important sign → cyanosis.
Other signs → dilated pupils, convulsions, unconsciousness.
First aid → remove cause + maintain airway + artificial respiration.
In drowning → position of patient → supine, head turned to side to drain water/vomit.
Heimlich maneuver is used in → foreign body airway obstruction (choking).
Mouth-to-mouth is preferred over manual methods → more effective.
Asphyxia due to CO poisoning → cherry-red color of lips and skin.
In strangulation/hanging → ligature mark present around neck.
In electric shock → respiratory arrest is main cause of asphyxia.
Most dangerous complication of asphyxia → brain hypoxia leading to permanent damage.