1. Shock

2. What is Shock?
• Shock is defined as a condition in which
systemic Blood Pressure is inadequate to
deliver oxygen and nutrient to support vital
organs and cellular function.

3. What are the Types of Shock?
• Hypovolemic Shock
• Cardiogenic shock
• Distributive shock
– Septic shock
– Anaphylactic shock
– Neurogenic Shock

4. What are the stages of Shock?
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Initial stage
Compensatory stage
Progressive stage
Refractory stage

5. Pathophysiology
1. Initial Stage
Cardiac Output
Tissue perfusion
2. Compensatory Stage
a. Neural response
HR and contractility,
arterial & venous
vasoconstriction, shunting
of blood to the vital organs

6. b. Hormonal response
i. Activation of the Renin
response
Production of Angiotensin II
Vasoconstriction & release of
aldosterone & ADH
release
Sodium & water release

7. ii. Stimulation of anterior
pituitary
Secretes ACTH
Stimulates adrenal cortex
Release of glucocorticoids
Blood glucose levels

8. iii. Stimulation of adrenal
medulla
Release of epinephrine &
nor-epinephrine
3. Progressive stage
Failure to meet the tissue
metabolic needs
Activation of anaerobic
metabolism

9. Irreversible damage to
cells
Lactic acedemia
Further decreased tissue
Failure of Na++-K+ Pump
perfusion
Mitochondria swells up
and ruptures
Death of cell

10. Clinical consequences
4. Refractory stage
MODS
Irreversible shock
Death

11. What are the Consequences of shock?
• Cardiovascular
– Ventricular filure
– Microvascular thrombosis
• Neurologic
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SNS dysfunction
Cardiac and respiratory depression
Thermoregulatory failure
Coma

12. • Pulmonary
– Acute respiratory failure
– Acute lung injury
• Renal
– Acute tubular necrosis (ATN)
• Hematologic
– Disseminated Intravascular Coagulation (DIC)
• Gastro intestinal
– GIT failure
– Hepatic failure
– Pancreatic failure

13. What are the Diagnostic criteria
for Shock?
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SBP less than 90 mm of Hg
Tachycardia
Altered Mental status
Altered serum lactate and base levels

14. How do we manage Shock?
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Maintain patent airway
Improve ventilation and oxygenation
Vasoconstrictors – Epinphrine, nor-epinephrine
Vasodilators- Nitroprusside, nitroglycerine
Inotropes- Dobutamine, Epinphrine
Antidysrrhythmics- Lidocaine, amiodarone

15. Thank you