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Seminar: Approach to 
Shock 
Abdul Waris Khan 
4th Year (Medicine)
Definition 
• Shock is the term used to describe acute circulatory 
failure with inadequate or inappropriately 
distribute...
Causes of shock 
 Abnormalities of tissue perfusion may result from: 
 failure of the heart to act as an effective pump ...
CLINICAL FEATURES OF SHOCK 
Hypovolaemic shock 
 Inadequate tissue perfusion: 
(a) Skin – cold, pale, slate-grey, slow ca...
Cardiogenic shock 
• Signs of myocardial failure, e.g. 
• Raised jugular venous pressure (JVP) 
• Pulsus alternans, 
• ‘G...
Obstructive shock 
• Elevated JVP. 
• Pulsus paradoxus and muffled heart sounds in 
cardiac tamponade. 
• Signs of pulmon...
Anaphylactic shock 
Signs of profound vasodilatation: 
(a) Warm peripheries 
(b) Low blood pressure 
(c) Tachycardia. 
■ ...
• Sepsis, severe sepsis and septic shock 
■ Pyrexia and rigors, or hypothermia (unusual). 
■ Nausea, vomiting. 
■ Vasodila...
Assessment of tissue perfusion 
■ Pale, cold skin, delayed capillary refill and the 
absence of 
visible veins in the hand...
References 
• Kumar & Clark’s Clinical Medicine 7th edition
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Shock

  1. 1. Seminar: Approach to Shock Abdul Waris Khan 4th Year (Medicine)
  2. 2. Definition • Shock is the term used to describe acute circulatory failure with inadequate or inappropriately distributed tissue perfusion resulting in generalized cellular hypoxia and/or an in ability of the cells to utilize oxygen.
  3. 3. Causes of shock  Abnormalities of tissue perfusion may result from:  failure of the heart to act as an effective pump  mechanical impediments to forward flow  loss of circulatory volume  abnormalities of the peripheral circulation.
  4. 4. CLINICAL FEATURES OF SHOCK Hypovolaemic shock  Inadequate tissue perfusion: (a) Skin – cold, pale, slate-grey, slow capillary refill, ‘clammy’ (b) Kidneys – oliguria, anuria (c) Brain – drowsiness, confusion and irritability.  Increased sympathetic tone: (a) Tachycardia, narrowed pulse pressure, ‘weak’ or ‘thready’ pulse (b) Sweating (c) Blood pressure – may be maintained initially (despite up to a 25% reduction in circulating volume if the patient is young and fit), but later hypotension supervenes.  Metabolic acidosis – compensatory tachypnoea.
  5. 5. Cardiogenic shock • Signs of myocardial failure, e.g. • Raised jugular venous pressure (JVP) • Pulsus alternans, • ‘Gallop’ rhythm, • Basal crackles, • Pulmonary oedema.
  6. 6. Obstructive shock • Elevated JVP. • Pulsus paradoxus and muffled heart sounds in cardiac tamponade. • Signs of pulmonary embolism
  7. 7. Anaphylactic shock Signs of profound vasodilatation: (a) Warm peripheries (b) Low blood pressure (c) Tachycardia. ■ Erythema, urticaria, pallor, cyanosis. ■ Bronchospasm, rhinitis. ■ Oedema of the face, pharynx and larynx. ■ Hypovolaemia due to capillary leak. ■ Nausea, vomiting, abdominal cramps, diarrhoea.
  8. 8. • Sepsis, severe sepsis and septic shock ■ Pyrexia and rigors, or hypothermia (unusual). ■ Nausea, vomiting. ■ Vasodilatation, warm peripheries. ■ Bounding pulse. ■ Rapid capillary refill. ■ Hypotension (septic shock). ■ Occasionally signs of cutaneous vasoconstriction. ■ Other signs: (a) Jaundice (b) Coma, stupor (c) Bleeding due to coagulopathy (e.g. from vascular puncture sites, GI tract and surgical wounds) (d) Rash and meningism (c) Hyper-, and in more severe cases hypoglycaemia
  9. 9. Assessment of tissue perfusion ■ Pale, cold skin, delayed capillary refill and the absence of visible veins in the hands and feet indicate poor perfusion. ■ Metabolic acidosis with raised lactate concentration may suggest that tissue perfusion is sufficiently compromised to cause cellular hypoxia and anaerobic glycolysis. dysfunction. ■ Urinary flow is a sensitive indicator of renal perfusion and haemodynamic performance
  10. 10. References • Kumar & Clark’s Clinical Medicine 7th edition

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