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Shock

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Shock, Hypovolumic Shock , Cardiogenic Shock, Septic Shock

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Shock

  1. 1. Shock Dr. Deepak K. Gupta
  2. 2. Introduction • Shock is a life-threatening clinical syndrome of cardiovascular collapse. • Its characterised by: – an acute reduction of effective circulating blood volume (hypotension); – Leading to an inadequate perfusion of cells and tissues (hypoperfusion). • These two effect initially causes only reversible cellular injury, • But persistence of shock eventually causes irreversible tissue injury and may cause death www.facebook.com/notesdental
  3. 3. Classification • Based on etiology shock can be classified into – Hypovolaemic shock – Cardiogenic shock • Deficient emptying • Deficient filling • Obstruction to the outflow – Septic (Toxaemic) shock • Gram-negative septicaemia • Gram-positive septicaemia – Other types • Traumatic shock • Neurogenicshock • Hypoadrenal shock www.facebook.com/notesdental
  4. 4. Pathophysiology • All forms of shock involve following – Reduced effective circulating blood volume. – Reduced supply of oxygen to the cells and tissues with resultant anoxia. – Inflammatory mediators and toxins released from shock induced cellular injury www.facebook.com/notesdental
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  6. 6. PATHOGENESIS OF HYPOVOLAEMIC SHOCK • Inadequate circulating blood volume due to various causes. – Acute haemorrhage – Dehydration from vomitings, diarrhoea – Burns – Excessive use of diuretics – Acute pancreatitis • It may be again classified into 4 types, depending on the amount of blood loss – < 1000 ml: Compensated – 1000-1500 ml: Mild – 1500-2000 ml: Moderate – >2000 ml: Severe www.facebook.com/notesdental
  7. 7. PATHOGENESIS OF CARDIOGENIC SHOCK • Results from failure of the cardiac pump - severe left ventricular dysfunction. • This may be due to – Deficient emptying • Myocardial infarction • Cardiomyopathies • Rupture of the heart, ventricle or papillary muscle • Cardiac arrhythmias – Deficient filling: Cardiac temponade – Obstruction to the outflow • Pulmonary embolism • Ball valve thrombus • Tension pneumothorax • Dissecting aortic aneurysm www.facebook.com/notesdental
  8. 8. PATHOGENESIS OF SEPTIC SHOCK • Results from the host innate immune response to infectious organisms that may be blood borne or localized to a particular site – Most commonly due to gram-negative infections (endotoxic shock) – 70 % • bacterial wall lipopolysaccharides (LPS) consisting of a toxic fatty acid (lipid A) – common for all gram(+) • complex polysaccharide coat (including O antigen) unique for each species – But it can also occur with gram-positive (exotoxic shock) and fungal infections. • Analogous molecules in the walls www.facebook.com/notesdental
  9. 9. PATHOGENESIS OF SEPTIC SHOCK www.facebook.com/notesdental
  10. 10. PATHOGENESIS OF SEPTIC SHOCK • Various immunological events takes place – Activation of macrophage-monocytes – Activation of other inflammatory responses. • Complement pathway • Mast cells • Coagulation system • Kinin system www.facebook.com/notesdental
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  12. 12. PATHOGENESIS OF OTHER TYPES OF SHOCK • Traumatic shock – Severe injuries – Surgery with marked blood loss – Obstetrical trauma • Neurogenic shock – High cervical spinal cord injury – Accidental high spinal anaesthesia – Severe head injury • Hypoadrenal shock – Administration of high doses of glucocorticoids – Secondary adrenal insufficiency (e.g. in tuberculosis, metastatic disease, bilateral adrenal haemorrhage, idiopathic adrenal atrophy). • Anaphylactic shock – systemic vasodilation – increased vascular permeability – caused by an Ig E hypersensitivity reaction www.facebook.com/notesdental
  13. 13. STAGES OF SHOCK www.facebook.com/notesdental
  14. 14. References • Robbinson's basic pathology 8 ed • Harsh Mohan - Textbook of Pathology 6th Ed. • Color atlas of pathology www.facebook.com/notesdental

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