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shock

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shock

  1. 1. SHOCK
  2. 2. Definition <ul><li>Defined as a life threatening situation where the tissue perfusion is compromised to such an extent so as to cause impaired cellular metabolism manifested in turn by serious patho physiological abnormalities </li></ul>
  3. 3. Classification <ul><li>Vasovagal </li></ul><ul><li>Psychogenic </li></ul><ul><li>Neurogenic </li></ul><ul><li>Hypovolaemic </li></ul><ul><li>Traumatic </li></ul><ul><li>Burns </li></ul><ul><li>Cardiogenic </li></ul><ul><li>Septic </li></ul><ul><li>anaphylactic </li></ul>
  4. 4. Vasovagal shock <ul><li>Pooling of blood in large vascular reservoirs- limb muscles </li></ul><ul><li>Dialatation of splanchnic arteriolar bed </li></ul><ul><li>Reduced venous return to heart </li></ul>
  5. 5. Vasovagal shock <ul><li>Low cardiac output </li></ul><ul><li>Reflex bradycardia </li></ul><ul><li>Reduced cerebral perfusion </li></ul><ul><li>Loss of consciousness </li></ul>
  6. 6. Vasovagal shock <ul><li>Prostration & reflex vaso constriction </li></ul><ul><li>Increases venous return & output </li></ul><ul><li>Permanent damage if upright </li></ul>
  7. 7. Psychogenic shock <ul><li>Follows a sudden fright </li></ul><ul><li>Bad news </li></ul><ul><li>Severe pain – blow to the testis </li></ul>
  8. 8. Neurogenic shock <ul><li>Traumatic /pharmacological blockade of sympathetic system </li></ul><ul><li>Dialatation of resistance arterioles & capacitance veins </li></ul><ul><li>Relative hypovolaemia & hypotension </li></ul>
  9. 9. Neurogenic shock <ul><li>Low BP </li></ul><ul><li>Low output </li></ul><ul><li>Warm dry skin </li></ul>
  10. 10. Hypovolaemic shock <ul><li>Loss of intra vascular volume </li></ul><ul><li>Haemorrhage </li></ul><ul><li>Dehydration </li></ul><ul><li>diarrhea </li></ul>
  11. 11. Hypovolaemic shock <ul><li>BP maintained till 10 – 15% volume loss </li></ul><ul><li>Tachycardia & vasoconstriction </li></ul><ul><li>Trans capillary refill 1litre in 1 hour </li></ul><ul><li>Constriction of venous capacitance vessels </li></ul>
  12. 12. Traumatic shock <ul><li>Hypovolaemia </li></ul><ul><li>ext bleeding / internal bleeding </li></ul><ul><li>Fluid loss into contused tissues/dialated bowel </li></ul><ul><li>Direct trauma –heart, NS ,resp system </li></ul>
  13. 13. Burn shock <ul><li>Plasma loss </li></ul><ul><li>Generalised capillary leak > 25% </li></ul><ul><li>endotoxeamia </li></ul>
  14. 14. Cardiogenic shock <ul><li>MI </li></ul><ul><li>Massive pulmonary embolism </li></ul>
  15. 15. Myocardial infarction <ul><li>When 50% or more of LV damaged </li></ul><ul><li>Fluid overload – distention of LV – failure </li></ul><ul><li>Back pressure – pulmonary edema </li></ul>
  16. 16. Myocardial infarction <ul><li>Arrhythmias – pump failure </li></ul><ul><li>Hypovolaemia – excess sweating , vomiting , diarrhoea </li></ul>
  17. 17. Massive pulmonary embolism <ul><li>Deep veins </li></ul><ul><li>Air embolism > 50 ml </li></ul><ul><li>RVF if > 50% of pulm vasculature obstructed </li></ul>
  18. 18. Septic shock <ul><li>Hyperdynamic / warm </li></ul><ul><li>Hypodynamic / cold </li></ul>
  19. 19. Hyperdynamic / warm <ul><li>Gram negative infection </li></ul><ul><li>Strangulated intestine </li></ul><ul><li>Peritonitis </li></ul><ul><li>Leaking anastomoses </li></ul><ul><li>Biliary suppuration </li></ul>
  20. 20. Hyperdynamic / warm <ul><li>Increased output </li></ul><ul><li>Tachycardia </li></ul><ul><li>Warm dry skin </li></ul><ul><li>Blood shunted past cells which are damaged (anaerobic metabolism) </li></ul>
  21. 21. Hyperdynamic / warm <ul><li>Capillary membranes leak </li></ul><ul><li>Endotoxins are absorbed </li></ul><ul><li>SIRS </li></ul>
  22. 22. Hypodynamic / cold <ul><li>Severe sepsis /endotoxaemia persisting </li></ul><ul><li>Generalised capillary leakage </li></ul><ul><li>Severe hypovolaemia </li></ul>
  23. 23. Hypodynamic / cold <ul><li>Reduced output </li></ul><ul><li>Tachycardia </li></ul><ul><li>vasoconstriction </li></ul>
  24. 24. Hypodynamic / cold <ul><li>Cardiac depression </li></ul><ul><li>Pulm hypertension </li></ul><ul><li>Pulm edema </li></ul><ul><li>hypoxia </li></ul>
  25. 25. Hypodynamic / cold <ul><li>Cold , clammy , drowsy </li></ul><ul><li>Convert it to hyperdynamic –plasma / colloids </li></ul>
  26. 26. Anaphylactic shock <ul><li>Drugs </li></ul><ul><li>Serum </li></ul><ul><li>Stings </li></ul><ul><li>Shell fish </li></ul>
  27. 27. Anaphylactic shock <ul><li>Antigen combines with IgE on mast cells , basophils </li></ul><ul><li>Release histamine & SRS -A </li></ul>
  28. 28. Anaphylactic shock <ul><li>Bronchospasm </li></ul><ul><li>Laryngeal edema </li></ul><ul><li>Resp distress – hypoxia </li></ul>
  29. 29. Anaphylactic shock <ul><li>Massive vaso dialatation </li></ul><ul><li>Hypotension </li></ul><ul><li>shock </li></ul>

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