presentation on shock

1. Hypovolemic, Septic and
Cardiogenic Shock

2. Hypovolemic
Shock
Hypovolemic shock
is due to a reduced
circulating volume.
Hemorrhagic causes
1. External blood loss (wounds)
2. Internal bleeding (hematemesis, melena, epistaxis,
hemoptysis, hemothorax etc.)
3. Spontaneous bleeding (use of anticoagulant)
Non-hemorrhagic causes
1. GI losses (vomiting, diarrhea)
2. Renal (DM, diuretics overdose, osmotic substances,
hypoaldosteronism)
3. Skin (overheated environment, burns)
4. Third space losses (pleural effusion, pancreatitis)

5. • Blood Pressure
• Respiration
• Urine output
• Central venous pressure
• ECG
• Swan-Ganz catheter
Clinical Monitoring

6. • The pressure within the superior vena cava
or the right atrium, to provide information
about the body volume status & right
ventricular function
• In hypovolaemic shock, the blood volume is
decreased, so is the CVP, whereas in
cardiogenic shock there is no blood
depletion in blood volume and the CVP
remains normal
• Normal CVP: 0-8mmHg or 3-8cm H2O
• If less than 0 mmHg means Hypovolaemia
• If more than 8 mmHg means Hypervolaemia
Central Venous Pressure
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7. •Resuscitation
•Immediate control of bleeding
•Extracellular fluid replacement
•Drugs
Treatment

8. Resuscitation
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ADD A FOOTER
Start immediately
Establishment of clear airway and maintaining
adequate ventilation and oxygenation
Lowering the head with support of the jaw / leg
raise
prevent airway obstruction
Improve the venous return preventing stasis of
blood in the muscles of the leg
Prevent edema
Increase cerebral circulation
Presence of airway obstruction – intratracheal
intubation, mechanical ventilation

9. • Bandage compression to tamponade external
haemorrhage
• Operation maybe required to stop such bleeding
as soon as some resuscitation has been achieved
Immediate Control of Bleeding

10. Extracellular Fluid Replacement

11. • Sedatives
• Alleviate pains and reduce excessive consumption of O2
• Morphine IV
• In children barbiturate are preferred
• Vasopressors
• Vasopressors improve perfusion pressure in the large vessel but they
decrease capillary blood flow in the certain tissue bed (GI tract & peripheral
vasculature)
• Along with vasopressors, inotrope may be needed to increase CO by
increasing contractility & stroke volume
Drugs

12. Septic Shock
Septic shock is a subset
of sepsis with
circulatory and
metabolic dysfunction
associated with a higher
risk of mortality
Toxins are released from bacterial infections

13. CLINICAL FEATURES
• Initially – chills and temperature >100°F
• Early warm shock
• Late cold shock

14. WHO Stages of Septic Shock

16. TREATMENT
• Treatment of infection – early surgical debridement or drainage by use of
proper antibiotics
• Treatment of shock – fluid replacement, steroid administration, use of
vasoactive drugs
• Initial aggressive fluid resuscitation with IV isotonic crystalloids 30 mL/kg within 3 hrs
• additional fluid based on frequent reassessment
• empiric antibiotic therapy within one hr.
• For patients with septic shock requiring vasopressors, target a mean arterial pressure (MAP)
of 65 mmHg.
• The first choice of a vasopressor is norepinephrine, with the addition of vasopressin if
refractory

17. Cardiogenic
Shock
Inadequate systemic
perfusion despite
adequate circulating
volume, due to
decreased cardiac
output
Causes of cardiogenic shock include
myocardial infarction,
cardiac dysrhythmias,
valvular heart disease,
blunt myocardial injury
and cardiomyopathy
Cardiogenic shock has a mortality rate ranging from 50% to
75%

18. Pathophysiology
• RV dysfunction → inadequate blood to lungs → low filling volume of
left heart → decreased LV output.
• LV dysfunction → low stroke volume → low cardiac output.
• Engorged pulmonary vasculature in LVD due to normal RV output,
• Cardiac compressive shock – heart is compressed enough to ↓CO.

19. Clinical Features of Cardiogenic
Shock
 Early – pale & cool skin, low urine
output.
 Tachycardia, low BP.
 RVD – increased JVP,
hepatomegaly.
 LVD – bronchial crackles, S3
heard.
 Cardiomegaly gradually builds up.

20. Management

21. Reference
Das, S. (2019). A Manual on Clinical Surgery (15th ed.). Dr. S. Das.
Bhat M, S. (2019). SRB's Manual of Surgery (6th ed.). Jaypee Brothers
Medical Publishers (P) Ltd.
Shenoy, K. R., & Shenoy, A. (2014). Manipal Manual of Surgery (4th
ed.). CBS Publishers & Distributors Pvt. Ltd.
Williams, N. S., O' Connell, P. R., & McCaskie, A. W. (Eds.). (2018).
Bailey & Love’s Short Practice of Surgery (27th ed.). CRC Press Taylor
& Francis Group.