DIOSRDER OF HEMODYNAMIC: SHOCK AND EDEMA

1. HEMODYNAMIC
DISORDER
DR.ROSHAN KHATIWADA

2. Learning Objectives:
 Edema
 Shock

4. EDEMA:
 Edema refers to the presence of increased fluid in the interstitial space of
the ECF compartment.
 Types of edema:
i. Transudative: Is a protein-poor (<3 g/dL) and cell-poor fluid
ii. Exudative: Is a protein-rich (>3 g/dL) and cell-rich (e.g. neutrophils) fluid
iii. Lymphedema: Is a protein-rich lymphatic fluid that is present in the
interstitial tissue and/or body cavities
iv. Myxedema: Is a fluid that primarily consists of hyaluronic acid (a
glycosaminoglycan)

5. Exudate Vs Transudate:

6. Mechanism of EDEMA:
 Hydrostatic Pressure equates blood volume/flow and
favors movement of fluid out of the capillaries.
 Plasma colloid pressure equates with the serum albumin
level and opposes movement of fluid out of the
capillaries.
 In normal circumstances, plasma osmotic prseeure is
greater than hydrostatic pressure and fluid remains in
the capillaries.
 Elevated hydrostatic pressure or diminished colloid
osmotic pressure disrupts this balance and results in
increased movement of fliuid into interstitial space
and increased interstitial pressure.

7. Pathophysiology of Edema:

8. Causes of Edema:

13. SHOCK

14. SHOCK
 Shock is a state in which diminished cardiac output or reduced effective
circulating blood volume impairs tissue perfusion and leads to cellular
hypoxia.

15. Pathophysiology of Shock:

16. Classification of Shock:
1. Hypovolemic shock.
2. Cardiogenic shock.
3. Circulatory shock or distributive shock.
a) Septic shock.
b) Obstructive shock.
c) Neurogenic shock.
d) Anaphylactic shock

17. HYPOVOLEMIC Shock:
 Most common type of shock, due to insufficient circulatory volume.
 In hypovolemic shock there is decrease in circulatory volume to level that is inadequate to meet
body’s need for tissue oxygenation.
 This occurs when there is loss in the intravascular fluid up to 15% to 25%.
 Causes of hypovolemic shock:
i. Poor fluid intake
ii. High fever, insensible losses
iii. Hemorrhage
iv. Low cardiac output
v. Low cardiac pressures
vi. High SVR (sympathetic response)

18. Cardiogenic Shock:
 It is caused by the failure of heart to pump an adequate amount of blood to
vital organs. This will lead to reduction in cardiac output.
 Hallmark is low cardiac output
 High cardiac pressures
 High SVR (sympathetic response)
 Classic cause: large myocardial infarction
 Also seen in advanced heart failure (depressed LVEF)

19. Distributive Shock:
 In this there is no blood loss but the shock is due to the dilation of the blood
vessels.
 This displacement of blood causes a relative hypovolemia because not enough
blood returns to heart.
 Hallmark is low SVR
 Diffuse vasodilation and/or endothelial dysfunction
 Cardiac output classically high (variable)

20. Types of distributive shock:
a. Septic Shock: Shock secondary to infection with microorganisms. E.g.
Infection with gram negative organisms.
b. Obstructive Shock: Obstruction of blood flow results from cardiac arrest. E.g.
Cardiac tamponade, pneumothorax, pulmonary embolism, and aortic stenosis

21. c. Neurogenic Shock: It is most often seen in patients who have
had and extensive spinal cord injuries. The loss of autonomic and
motor reflexes below level of injury results in loss of sympathetic
control.
d. Anaphylactic Shock: Anaphylactic shock is caused by severe
reaction to an allergen, antigen, drug or foreign protein

22. Clinical Features of Shock:
i. Hypotension;
ii. Weak, rapid pulse (Tachycardia)
iii. Tachypnea
iv. Cool, clammy, cyanotic skin (Initially warm in distributive shock)
V. Decreased urine output
vi. Features of sepsis (In septic shock)

23. Management Approach of Shock: