shock is a life threatening medical condition characterized by inadequate tissue perfusion and hypoxia.

1. SHOCK
SUBMITTED BY-
MS. AMBIKA BAGORA

3. Shock is a life threatening medical
condition whereby the body suffers from
insufficient blood flow throughout the
body (circulatory collapse).
-It is characterized by inadequate tissue
perfusion in which there is insufficient
delivery of oxygen and nutrients to the
body’s tissues .

5. Causes-
 Heart conditions (heart attack, heart
failure).
 Heavy internal or external bleeding, such
as from a serious injury.
 Dehydration
 Infection
 Severe allergic reaction
 Spinal injuries

7. Types of shock-
1. Cardiogenic shock
2. Hypovolemic shock
3. Obstructive shock
4. Distributive shock
-Anaphylactic shock
-Septic shock
-Neurogenic shock

8. Other types-
1. Endocrine shock- Endocrine shock is
caused by a disturbance in the endocrine
system. Example –
- severe hypothyroidism
- thyrotoxicosis
- severe adrenal insufficiency
2. Insulin shock- shock resulting from an
overdosage of insuline which causes too
much reduction of blood sugar
characterized by sweating, trembling,
dizziness, with other shock features.

10. 1. Cardiogenic shock-
Cardiogenic Shock resulting from
inadequate pumping action of the heart
because of cardiac muscle dysfunction or
mechanical obstruction of blood flow.
 Causes of cardiogenic shock include-
acute myocardial infarction, rupture of
heart valves, acute myocarditis, end-stage
heart disease, severe dysrhythmias or
traumatic injury to the heart.

12. 2. Hypovolemic Shock-
This is the most common type of
shock and based on insufficient
circulating volume. It occurs due to
decrease in the circulating blood
volume resulting from-
- dehydration
- internal hemorrhage
- external hemorrhage
- burns with loss of plasma protien

13. 3. Obstructive shock- It occure when
there is a blockage of blood flow in the
cardiovascular circuit outside the
heart. Example- cardiac tamponade,
tension pneumothorax , massive
pulmonary embolism.
4. Distributive shock- It includes
anaphylactic shock, septic and
neurogenic shock.

14. I. Anaphylactic shock- It is a shock state
resulting from severe allergic reaction
producing overwhelming systemic
vasodilation and relative hypovolemia.
II. Septic shock- Septic shock is caused by
an overwhelming systemic infection and
inflammation resulting in vasodilation
leading to hypotension.
III. Neurogenic shock- Neurogenic shock
occurs when dysfunction or injury to the
nervous causes extensive vasodilatation
of peripheral blood vessels and
hypotension.

15. Stages of shock-
a. Initial stage- During this stage, the hypoperfusion
state causes hypoxia, and cells perform anerobic
respiration, this causes a build up of lactic acid
which results in systemic metabolic acidosis.
a. Compensatory stage- compensatory mechanism
are activated to maintain perfusion to heart and
brain. Reduce blood flow to the kidney activates the
rennin – angiotensin - aldosteron system (RAAS)
causing vasoconstriction and sodium and water
retention, leading to increased blood volume and
venous return. As a result of compensatory
mechanism, cardiac output and tissue perfusion are
maintaned

16. c. Progressive stage- The progressive stage
of shock begins as compensatory
mechanism fail to maintain cardiac output
and blood pressure starts to fall.
d. Irreversible stage- At this stage, the
vital organs have failed and the shock can
no longer be reversed. Eventually,
circulatory and respiratory failures occur.
Brain damage and cell death have
occurred. Death will occur imminently.

17. FINDINGS STAGES OF SHOCK
 Heart rate
Pulse
Respiration
BP
Skin
Urine output
A-B balance
Mental status
Compensatory Progressive Irreversible
Tachycardia
Bounding pulse
Tachypnea
Normal
Cool and pale
Normal/
Respiratory
alkalosis
Restless/irritable
Tachycardia
Weak pulse
Shallow
Hypotension
Cool, moist
Oliguria
Metabolic
acidosis
Confused
Slow heart rate
Weak/Absent
pulse
Slow
Worsen
hypotension
Cynosis
Anuria
Profound
acidosis
Unconcious

18. Overall management of shock-
Management in all types and all phases
of shock include the following-
1. Management of airway, breathing and
circulation.
2. Fluid replacement to restore
intravascular volume.
3. Vasoactive medication to restore
vasomotor tone and improve cardiac
function.

19. 1. Managment of airway,
breathing, and circulation-
 Fundamentals such as airway control, breathing and
circulatory support must be addresed as a higher
priority.
 Assessment of the adequacy of breathing and
whether it may need to be assisted with bag and
mask or intubation with an endotracheal tube and
mechanical ventilation may be necessary to
maintain a patent airway.
 Patient will be treated with oxygen
supplementation through nasal cannula, face mask
or ET tube.

21. 2. Fluid replacement to restore
intravascular volume-
 Beyond reversing the primary cause of
decreased intravascular volume, fluid
replacement is primary concern.
At least two intravenous lines with large
gauge needle should be initiated and
maintained for fluid and drug administration.
 Fluid administration- Intravenous fluid
crystalloids, colloids, or blood products may
be administered to maintain intravascular
fluid volume.

23. 1. Crystalloids- They are electrolyte solution that
moves free between intravascular compartment.
Common intravenous fluids are 0.9% normal
saline and riger lactate. Ringer’s lactate is the
initial fluid choice. Normal saline is the second
choice because hyperchloremic acidosis may
develop if massive amount normal saline is
infused.
2. Colloids- Intravascular colloidal solutions are
considered to be plasma protien, which are
molecules that are too large to pass through
capillary membranes. 5% albumin solution,
synthetic colloid preparations such as 6% beta
starch, 6% dextran and hetastarch solution are
administered to increase or maintain intravascular
fluid volume

24. 3. Blood transfusion- Blood transfusion is
necessary for loss of large amounts of
blood (e.g. Greater than 20% of blood
volume).
- Blood may be transfused if bleeding
(hemorrhage) is the cause of shock state.
- Packed R.B.Cs. Are infused when there is
massive blood loss.

25. 3. Vasoactive medication
 Vasoconstrictor drugs- They work by
stimulating the heart beat stronger and by
squeezing blood vessels to increase the
flow within them. Vasoactive medications
are frequently used in the management of
shock to increase mean arterial blood
pressure (MAP), restore organ perfusion
and oxygen delivery.

26.  Following are vasoconstructive drugs-
1. DOPAMIN- Low doses (1-3
ug/kg/min.) act only on dopamin
receptors in kidney to increase blood flow.
Medium doses (3-10 ug/kg/min) acts on
beta receptor to increase cardiac
contractility and cardiac output. Higher
doses (10 ug/kg/min) act on alpha
receptors to act as vasoconstrictor

27. 2. DOBUTAMINE- It acts on both a1 and
a2 receptors of the sympathetic nervous
system. Dobutamine increases cardiac
output by help heart to pump better by
strengthening the heart muscle and also
improves blood flow by vasodilation.
 Dobutamine is good for cardiogenic
shock. Usual doses to increase cardiac
output are 2.5-15 mcg/kg/min IV.

28. 3. NOREPINEPHRINE- It is also known
as noradrenaline is an apha agonist
(causes vasoconstriction) and some beta
activity (increases heart contractility).
Doses 8-12 mcg/min. Titrate to BP. Usual
maintenance dose 2-4 mcg/min.
4. EPINEPHRINE- Epinephrine is also an
alpha agonist and some beta agonist
activity. Epinephrine causes more
tachycardia than norepinephrine.
Continuous IV infusion 1-10 mcg/min
titrate dosage to desired effect.