4. Definition of shock
• Shock defined as inadequate delivery of oxygen and nutrients to
maintain normal tissue and cellular function. (Schwartz)
5. Epidemiology
• Shock occurs in 2% of all hospitalized patients in USA .
• Death usually occur due to complications rather than during hypotensive
phase.
• Mortality in septic shock as low as 3% in previously health children and 6-9%
in children with chronic illness .
6. Pathophysiology of shock
• Hypovolemic shock effective circulating blood volume
• Hemorrhage
• Truma venous return to heart
• Surgery cardiac output
• Burns blood flow
• Dehydration supply of oxygen
• Septic shock Anoxia
• Cardiogenic shock shock
9. Type Of Shock
Hypovolemic shock
Cardiogenic shock
Distributive shock (tension pneumothorax ,cardiac tamponed )
Obstructive shock
Septic shock
10. General clinical features
• Hypotension (SBP <100mmhg)
• Tachycardia>100/min
• Cold
• Rapid, Shallow respiration
• Drowsiness,confusion,irritability
• Oliguria(urine output<30 ml/h
• Multi organ failure
11. Hypovolemic shock
•Definition:
• Is an emergency condition in which severe blood and fluid loss make the
heart unable to pump enough blood to the body .
This type of shock can cause many organs to stop working .
12. Pathophysiology
Hemorrhage from small venules and veins (50%)
Decreased filling of right heart
Decreased filling of pulmonary vasculature
Decreased filling of left atrium and ventricle
Left ventricular stroke volume decreases
Drop in atrial blood pressure and tachycardia
Poor perfusion to pulmonary arteries
Cardiac depression and pump failure
16. Compensatory Mechanisms
1. Adrenergic discharge
2. Hyperventilation
3. Vasoactive hormones (angiotensin , vasopressin , epinephrine )
4. Re-absorption of fluid from interstitial tissue
5. Resorption of fluid from intercellular to extracellular space
6. Renal conservation of body water and electrolyte.
20. Management
•objective :
• A: Increase cardiac output
• B: increase tissue perfusion
The plan of action should be based on :
A: primary problem (stop bleeding)
B: Adequate fluid replacement
c : blood transfusion (Hb= 7 to 9)
d: improving myocardial contractility
e: correcting acid-base disturbances
21. Cont.…
Resuscitation
Immediate control of bleeding (rest , pressure Peking and surgical
methods)]
Infusion of fluid is the fundamental treatment
Crystalloids fluid
Colloids fluid (after crystalloid)
Drugs :
1.sedatives
2.chronotropic agent
3.inotropic agent