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Shock
What is Shock?
• Shock is defined as a condition in which
systemic Blood Pressure is inadequate to
deliver oxygen and nutrient to support vital
organs and cellular function.
What are the Types of Shock?
• Hypovolemic Shock
• Cardiogenic shock
• Distributive shock
– Septic shock
– Anaphylactic shock
– Neurogenic Shock
What are the stages of Shock?
•
•
•
•

Initial stage
Compensatory stage
Progressive stage
Refractory stage
Pathophysiology
1. Initial Stage

Cardiac Output

Tissue perfusion
2. Compensatory Stage
a. Neural response

HR and contractility,
arterial & venous
vasoconstriction, shunting
of blood to the vital organs
b. Hormonal response

i. Activation of the Renin
response
Production of Angiotensin II

Vasoconstriction & release of
aldosterone & ADH
release
Sodium & water release
ii. Stimulation of anterior
pituitary
Secretes ACTH

Stimulates adrenal cortex
Release of glucocorticoids
Blood glucose levels
iii. Stimulation of adrenal
medulla
Release of epinephrine &
nor-epinephrine
3. Progressive stage

Failure to meet the tissue
metabolic needs
Activation of anaerobic
metabolism
Irreversible damage to
cells

Lactic acedemia

Further decreased tissue
Failure of Na++-K+ Pump
perfusion

Mitochondria swells up
and ruptures
Death of cell
Clinical consequences
4. Refractory stage

MODS
Irreversible shock

Death
What are the Consequences of shock?
• Cardiovascular
– Ventricular filure
– Microvascular thrombosis

• Neurologic
•
•
•
•

SNS dysfunction
Cardiac and respiratory depression
Thermoregulatory failure
Coma
• Pulmonary
– Acute respiratory failure
– Acute lung injury

• Renal
– Acute tubular necrosis (ATN)

• Hematologic
– Disseminated Intravascular Coagulation (DIC)

• Gastro intestinal
– GIT failure
– Hepatic failure
– Pancreatic failure
What are the Diagnostic criteria
for Shock?
•
•
•
•

SBP less than 90 mm of Hg
Tachycardia
Altered Mental status
Altered serum lactate and base levels
How do we manage Shock?
•
•
•
•
•
•

Maintain patent airway
Improve ventilation and oxygenation
Vasoconstrictors – Epinphrine, nor-epinephrine
Vasodilators- Nitroprusside, nitroglycerine
Inotropes- Dobutamine, Epinphrine
Antidysrrhythmics- Lidocaine, amiodarone
Thank you

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Shock

  • 2. What is Shock? • Shock is defined as a condition in which systemic Blood Pressure is inadequate to deliver oxygen and nutrient to support vital organs and cellular function.
  • 3. What are the Types of Shock? • Hypovolemic Shock • Cardiogenic shock • Distributive shock – Septic shock – Anaphylactic shock – Neurogenic Shock
  • 4. What are the stages of Shock? • • • • Initial stage Compensatory stage Progressive stage Refractory stage
  • 5. Pathophysiology 1. Initial Stage Cardiac Output Tissue perfusion 2. Compensatory Stage a. Neural response HR and contractility, arterial & venous vasoconstriction, shunting of blood to the vital organs
  • 6. b. Hormonal response i. Activation of the Renin response Production of Angiotensin II Vasoconstriction & release of aldosterone & ADH release Sodium & water release
  • 7. ii. Stimulation of anterior pituitary Secretes ACTH Stimulates adrenal cortex Release of glucocorticoids Blood glucose levels
  • 8. iii. Stimulation of adrenal medulla Release of epinephrine & nor-epinephrine 3. Progressive stage Failure to meet the tissue metabolic needs Activation of anaerobic metabolism
  • 9. Irreversible damage to cells Lactic acedemia Further decreased tissue Failure of Na++-K+ Pump perfusion Mitochondria swells up and ruptures Death of cell
  • 10. Clinical consequences 4. Refractory stage MODS Irreversible shock Death
  • 11. What are the Consequences of shock? • Cardiovascular – Ventricular filure – Microvascular thrombosis • Neurologic • • • • SNS dysfunction Cardiac and respiratory depression Thermoregulatory failure Coma
  • 12. • Pulmonary – Acute respiratory failure – Acute lung injury • Renal – Acute tubular necrosis (ATN) • Hematologic – Disseminated Intravascular Coagulation (DIC) • Gastro intestinal – GIT failure – Hepatic failure – Pancreatic failure
  • 13. What are the Diagnostic criteria for Shock? • • • • SBP less than 90 mm of Hg Tachycardia Altered Mental status Altered serum lactate and base levels
  • 14. How do we manage Shock? • • • • • • Maintain patent airway Improve ventilation and oxygenation Vasoconstrictors – Epinphrine, nor-epinephrine Vasodilators- Nitroprusside, nitroglycerine Inotropes- Dobutamine, Epinphrine Antidysrrhythmics- Lidocaine, amiodarone