Shock is defined as inadequate delivery of oxygen and nutrients to tissues and cells. It occurs in 2% of hospitalized patients and mortality depends on the underlying cause. Pathophysiology involves reduced blood flow from decreased circulating volume or cardiac dysfunction. Stages include initial compensated shock progressing to decompensated irreversible shock. Types are hypovolemic, cardiogenic, distributive, obstructive, and septic shock. General signs are hypotension, tachycardia, coldness, rapid breathing, and organ dysfunction. Hypovolemic shock results from blood or fluid loss which decreases venous return and cardiac output. Risk factors include trauma, bleeding, burns, and dehydration. Treatment focuses on fluid res

1. ‫الرحیم‬ ‫الرحمن‬ ‫بسم‬
‫عامه‬ ‫صحت‬ ‫وزارت‬
‫تخصص‬ ‫اکمال‬ ‫ریاست‬
‫وانکشاف‬ ‫آموزش‬ ‫آمریت‬
‫صدری‬ ‫جراحی‬ ‫دیپارتمنت‬
Supervised By Sp.Dr.Rahmani
Prepared by Dr.Anush
Shock

2. Shock•Objective :
• 1.Defination
• 2.epidimology
• 3.pathophysiology
• 4.stage of shock
• 5.type of shock
• 6.general clinical future
• 7.hypovolemic shock

3. quastions
• Shcok indix : pr/sbp
• Cardiac indix:
• Monify indix shock:main art pressure /sbp

4. Definition of shock
• Shock defined as inadequate delivery of oxygen and nutrients to
maintain normal tissue and cellular function. (Schwartz)

5. Epidemiology
• Shock occurs in 2% of all hospitalized patients in USA .
• Death usually occur due to complications rather than during hypotensive
phase.
• Mortality in septic shock as low as 3% in previously health children and 6-9%
in children with chronic illness .

6. Pathophysiology of shock
• Hypovolemic shock effective circulating blood volume
• Hemorrhage
• Truma venous return to heart
• Surgery cardiac output
• Burns blood flow
• Dehydration supply of oxygen
• Septic shock Anoxia
• Cardiogenic shock shock

7. Stages of shock
Non=progressive (Initial, Compensated reversible )Shock
Progressive Decompensated shock
Decompensated (Irreversible)Shock

9. Type Of Shock
Hypovolemic shock
Cardiogenic shock
Distributive shock (tension pneumothorax ,cardiac tamponed )
Obstructive shock
Septic shock

10. General clinical features
• Hypotension (SBP <100mmhg)
• Tachycardia>100/min
• Cold
• Rapid, Shallow respiration
• Drowsiness,confusion,irritability
• Oliguria(urine output<30 ml/h
• Multi organ failure

11. Hypovolemic shock
•Definition:
• Is an emergency condition in which severe blood and fluid loss make the
heart unable to pump enough blood to the body .
This type of shock can cause many organs to stop working .

12. Pathophysiology
Hemorrhage from small venules and veins (50%)
Decreased filling of right heart
Decreased filling of pulmonary vasculature
Decreased filling of left atrium and ventricle
Left ventricular stroke volume decreases
Drop in atrial blood pressure and tachycardia
Poor perfusion to pulmonary arteries
Cardiac depression and pump failure

13. Risk factors for hypovolemic shock

14. Classification of hypovolemic shock
Hemorrhagic :
Truma
Gastrointestinal Bleeding
Non Hemorrhagic :
oExternal fluid loss
oDiarrhea
oVomiting
oPolyuria
o burns
oAnaphylaxis

15. Classification of acute blood loss

16. Compensatory Mechanisms
1. Adrenergic discharge
2. Hyperventilation
3. Vasoactive hormones (angiotensin , vasopressin , epinephrine )
4. Re-absorption of fluid from interstitial tissue
5. Resorption of fluid from intercellular to extracellular space
6. Renal conservation of body water and electrolyte.

17. Signs and symptoms
Restlessness
Hypotension
Cool
Rapid and shallow respiration
Hypothermia
Thirst and dry mouth
Distracted look in the eye

18. Clinical monitoring
Blood pressure
Respiration
Urine output
ECG
Swan-Ganz Catheter
Cardiac output
Venous oxygen level
Vascular pressure

19. Diagnosis
• Evaluation (agitation, cold Ext,tachycardia,hypotention)(25-30%B.Loss)
• Physical Exam: Ab,Chest ,Pelvic
• Hemorrhage (external , intrathoracic , intra Ab, Introperitoneal and long
bon fracture) .
• Chest X-Ray
• Pelvic radiography
• Diagnostic ultrasound
• Diagnostic peritoneal lavage

20. Management
•objective :
• A: Increase cardiac output
• B: increase tissue perfusion
The plan of action should be based on :
A: primary problem (stop bleeding)
B: Adequate fluid replacement
c : blood transfusion (Hb= 7 to 9)
d: improving myocardial contractility
e: correcting acid-base disturbances

21. Cont.…
Resuscitation
Immediate control of bleeding (rest , pressure Peking and surgical
methods)]
Infusion of fluid is the fundamental treatment
Crystalloids fluid
Colloids fluid (after crystalloid)
Drugs :
 1.sedatives
 2.chronotropic agent
 3.inotropic agent

22. Thank you.