Shock is a life threatening emergency which all physicians must know.
This slide helps in the understanding of shock, it's definition/classification/pathophysiology/clinical features/investigations and assessment of shock..
2. OBJECTIVES
• Definitions and terms
• Determinants of oxygen
• Classification of shock with causes
• stages of shock
• clinica features
• investigations
• summary of septic shock and shock index
3. DEFINITIONS AND TERMS
• SHOCK:
• state of cellular and tissue hypoxia due to either reduced oxygen delivery, increased oxygen
consumption or inadequate oxygen utilization.
• clinical condition of oxygen dysfunction due to an imbalance between oxygen supply and oxygen
demand.
• UNDIFFERENTIATED SHOCK: shock is recognized but cause is unknown.
• MIXED SHOCK: patient presents with more than one type of shock.
• NOTE: initially, shock is reversible with treatment but irreversible if untreated and can lead to
multisystemic organ failure.
• DETERMINANTS OF OXYGEN
• preload
• myocardial contractility
• systemic vascular resistance
• hemglobin combined with the blood(hb×1.39×Saturation of oxygen)
• oxygen dissolved in blood(partial pressure of oxygen×0.03)
• NOTE: if any of the components above are affected can lead to shock.
5. TYPES OF CARDIOGENIC SHOCK
• FUNCTIONAL: associated with functional defect of heart( as in ischaemic heart disease)
• COMPRESSIVE: associated with mechanical or exteranal compression( cardiac tamponade, tension
pneumothorax, positive pressure ventilation)
• OBSTRUCTIVE: associated with obstruction to flow( valvular insufficiency, tension pneumothorax)
19. • PRACTICAL DEFINITION OF SEPTIC SHOCK: Despite fluid resuscitation=
• 1.) hypotension requiring vasopressors to maintain mean arterial pressure of less than 65mmHg
• 2.) elevated lactate levels of greater than 2mmol/l
• RISK FACTORS
• Supressed immune response
• Extreme age(infant/elderly)
• People who received an organ transplant
• Surgical procedures(invasive)
• Infection/indwelling devices
• Sickness(chronic illness)-diabetes mellitus, alcoholism, liver/renal failure.
• CLINICAL FEATURES
• T-increasedor decreased temperature
• I-symptoms and signs of infection
• M-mentally declined(confused, sleepy, inability to arouse)
• E-extremely ill(severe pain,discomfort,dyspnoea)
20. ASSEMENT OF SHOCK PATIENT
• SHOCK INDEX(SI)=Heart rate over systolic blood pressure(HR/SBP)
• MODIFIED SHOCK INDEX(MSI)=Heart rate over mean arterial pressure(HR/MAP)
• shock index of:
• ≥0.6 to <1=mild shock
• ≥1 to < 1.4=moderate shock
• ≥ 1.4=severe shock
• Increased MSI/SI is seen in: hypovolemic shock, cardiogenic shock, septic shock
• Decreased MSI/SI is seen: neurogenic shock
21. REFERENCES
• MEDICINE_PREP MANUAL OF MEDICINE(5TH EDITION) NY K.GEORGE MATHEW, E’TAL..
• SHOCK BY DR SHUBHAM UPADHYAY
• APPROACH TO A SHOCK PATIENT BY DR HOPE MUTENGO
• HARRISON’S MANUAL OF MEDICINE(20TH EDITION) BY DR FAUCI, E’TAL..
• SHOCK-BASIC-PRINCIPLES IN SURGERY BY DR .B. SELVARAJ
• KUMAR AND CLARK’S CLINICAL MEDICINE(10TH EDITION) BY PROFESSOR DAME PARVEEN J
KUMAR, E’TAL...
22. • NEXT SLIDE: SOFA SCORE/QSOFA SCORE AMD
MANAGEMENT OF SHOCK
• THANK YOU.....