Shock is a life-threatening condition characterized by inadequate tissue perfusion and low blood pressure. There are several types of shock including hypovolemic, cardiogenic, anaphylactic, septic, neurogenic, and endocrine shock. Signs of shock include low blood pressure, fast heart rate, pale and sweaty skin, confusion, and decreased urine output. Treatment focuses on ABCs - airway, breathing, circulation. IV fluids are given to restore blood volume while medications like epinephrine and vasopressors may be used to support blood pressure. Without prompt treatment, shock can lead to multiple organ failure and death.

1. DR Elias Arteen
Consultant Surgeon
F.R.C.S.I.

2. Shock
Definition of Shock
Shock is a clinical condition of circulatory failure
characterized by inadequate tissue perfusion
(tissue Hypoxia).
Shock requires immediate medical treatment
and can get worse very rapidly.

3. WHAT IS SHOCK?
Inadequate Tissue
Perfusion

4. Shock
Introduction:
Shock is a life threatening condition.
Shock can damage multiple organ.
Blood flow to the organ depends on the blood
pressure of the vessels suppling the organ.
The blood pressure is consider the outcome of
pump (Heart) ejecting fluid (Blood) against
peripheral resistance ( The tone of arterioles)
B.P= VR Pump P.R
Hypotension Perfusion failure shock.

5. Circulatory Homeostasis
BP = CO X PVR
CO – Cardiac Output
PVR – Peripheral Vascular resistance
Tissue perfusion is driven by blood pressure

6. Cardiac Output
CO = SV X HR
This means that
BP= SV X HR X PVR
Blood Pressure = Stroke Volume X Heart Rate X Peripheral Vascular Resistance

7. Shock
Classification of shock:
Cardiogenic shock (associated with heart problems)
Hypovolemic shock (caused by inadequate Blood
volume)
Anaphylactic shock (associated with allergic reaction)
Septic shock (associated with infections)
Neurogenic shock (cause by damage to the nervous
system)
Endocrine shock
A person in shock has extremely low blood pressure

8. Stroke Volume
Volume of Blood pumped by the heart during 1
cycle
What affects Stroke volume?
Heart
Muscle
Damag
e
Blood
Volume
Mechanica
lObstructi
on
Mechanic
al
Rhythm
Problems

9. Types of Shock
Hypovolaemic
Cardiogenic
Redistributive

10. Redistributive
Decreased Peripheral Vascular
Resistance
Septic Shock
Spinal / Neurogenic Shock
ANAPHYLACTIC shock

11. Symptoms of Shock
Anxiety
/Nervousness
Dizziness
Weakness
Faintness
Nausea & Vomiting
Thirst
Confusion
Decreased UO
Hx of Trauma /
other illness
Vomiting &
Diarrhoea
Chest Pain
Fevers / Rigors
General
Symptoms
Specific
Symptoms

12. Signs of Shock
Pale
Cold & Clammy
Sweating
Cyanosis
Tachycardia
Tachypnoea
Confused / Agitated
Unconscious
Hypotensive
Stridor / SOB

13. Shock
First Aid in shock:
Check the patients airway, Breathing and circulation (ABC)
Begin rescue breathing and CPR if necessary
Lay the patients on the back and elevate the legs about 12
inches if the patients is conscious and no injuries to the
head, neck, spine and legs. (shock position)

14. Shock
Give appropriate first aid
management for any
wounds injuries and
illnesses.
Keep the patient warm and
comfortable and loosen tight
clothing.
Turn the head to one side if
the patient vomits so he will
not choke (providing that he
has no spinal injuries)

15. Treatment of Shock
ABC

16. Treatment of Shock
Ensure Adequate Intravascular Volume
Support Pump

17. Treatment
Ensure Airway is
adequate
Oxygen
IV access early
IV fluids
ADRENALINE
0.5ml 1 in 1000
IM
Bronchodilators
Steroids

18. Shock
Cardiogenic Shock:
Definition:
Cardiogenic shock occurs when the heart is
damaged enough and become unable to supply
sufficient blood to the body due to disorders of
the heart muscle, the valve, or electrical
conduction system.

19. Shock
Causes and risk factor:
Heart attack
Heart failure
Cardiomyopathy
Rupture of the heart
Abnormal heart rhythms
Heart valve disorders

20. Shock
Clinical picture (Symptoms- Signs)
Thread rapid pulse
Anxiety, nervousness and decreased mental status.
Profuse sweating
Moist skin
Diagnosis
Tests used in patients with cardiogenic shock
Electrocardiogram (ECG)
Coronary Angiography
Echocardiogram.
Lab. Exam. For cardiac enzymes and arterial blood
gases.

21. Shock
Treatment:
Cardiogenic shock is a medical emergency.
The goal and treatment is to save the patient, live and
treating the underlying cause.
Hospitalization
Intropic drugs to improve cardiac contractility,
function and restore blood pressure
Pain control.
Bed rest to reduce demands on the heart.
Oxygen to reduce the workload of the heart by
reducing tissue demands of blood flow
Cardiac pacing (pacemaker)
80% of cases of cardiogenic shock is fatal.

22. Shock
Complications shock
Multiorgans damage MOF
( Kidney, Brain and Liver)

23. Shock
Hypovolemic shock
Definition
A particular form of shock which caused by blood
loss or inadequate blood volume loss of one-fifth
or more of the normal blood volume produces
hypovolemic shock.

24. Shock
Causes:
External bleeding from cuts or injuries.
Internal bleeding from gastrointestinal bleeding
and others.
Diminished blood volume from excessive loss of
other body fluid, i.e. Diarrhea, vomiting, Burns
and others

25. Shock
Clinical picture:
CNS: Anxiety, confusion, unconsciousness
CVS: Rapid Thread pulse, Low blood pressure.
Thoracic: Rapid breathing.
Skin: Cool clammy, Sweating.
Kidney: Decreased or no urine out.

26. Shock
Diagnostic tests:
Laboratory: CBC, PT, INR, APTT and others.
Radiology: X-rays and CT scan of suspected
sites.
Endoscopy: Upper and lower GI.
Echocardiogram and swan-Gan2
catheterization to confirm and differentiate
between Hypovolemic and cardiogenic shock

27. Shock
Treatment: ( ABC )
Shock Position
Oxygen Avoid Hypothermia
Hospitalization
Rapid replacement of blood loss
Control External bleeding
Close monitoring, Urinary catheter, CVP, S.G.C
Complications: Multiorgan failure, Brain,
Kidney, Lung, Liver and others .

28. Shock
Anaphylactic shock:
Definition:
Anaphylaxis is life-threatening of server hole
body allergic reaction. Anaphylaxis can occur in
response to any allergen (Antigen) ie insect bites,
Horse serum, used for vaccines, food, drugs.
After an initial exposure to a substance the
person’s immune system become sensitized to
that allergen on subsequent exposure an allergic
reaction occurs

29. Shock
Causes and Risk Factors:
Histamine and other substances released from the
tissue which can cause
Air way constriction (Wheezing)
Breathing difficulty.
Abdominal pain, Vomiting and diarrhea
Blood vessels dilation and lowering Bp
Decrease blood volume due to fluid leak from the
blood stream
Pulmonary edema due to fluid leak to the alveoli of
the lung

30. Shock
Clinical picture:
Weak pulse
Low blood pressure and shock
Breathing difficulty – pulmonary edema, air
way obstruction.
Confusion.
Skin redness
Generalized Itching
Nasal congestion
Angioedema (edema of lips, eye lids throat
and tongues)

31. Shock
Treatment:
Anaphylaxis is on emergency condition require
immediate professional medical attention.
Assessment of ABC’s
Intravenous Hydrocortisone
Intravenous crystalloid infusion
Antihistaminic
Endotracheal Intubation and ventilation for
laryngeal edema and stridor
Anaphylaxis is a severe disorder which has poor
prognosis without prompt treatment.

32. Shock
Septic Shock
Bacteremia shock, Endotoxic shock, Septicemia
shock, warm shock
Definition: Septic shock is a serious abnormal
condition that occur when an overwhelming
infection leads to low blood pressure and low
blood volume

33. Shock
Incidence and risk factors
Extreme of age ( very young and very old)
Underlying illnesses
Diabetes, lymphoma, leukemia and other
malignancies.
Recent infection
Prolonged antibiotic therapy
Recent surgical procedure.

34. Shock
Causes
Bacterial ( gram negative Bacilli and gram positive cocci)
Rarely viruses.
rarely fungi
Example infected central venous line, peritonitis,
pneumonia
Mechanism
Toxins released by bacteria, fungi or viruses cause direct
tissue damage and may lead to low blood pressure and
poor organ function
Toxins produce a vigorous inflammatory response from
the body (cytokines) which lead to septic shock

35. Shock
Clinical picture: (Symptoms and signs)
High (early) or very low temperature (late)
with chills
Dyspnea (shortness of breath)
Palpitations
Cool, pale extremities
Restlessness, agitation or confusion
Rapid heart rate
Low blood pressure (especially when
standing)
Low urine output

36. Shock
Tests for diagnosis
Blood gases: reveal low oxygen concentration
and acidosis
Blood culture to detect infection
Specific blood tests to detect poor organ function
or failure ( KFT, LFT, P.T, INR and others(

37. Shock
Treatment
Septic shock is a medical emergency and
patient are usually admitted to ICU
Provide oxygen: Nasal cannula, mask, CPAP,
IT intubations and ventilation
IV fluid (crystalloid and colloid)
Vasoactive drugs: noradrenalin, Dopamine
Antibiotic to treat the underlying infection
Support the poorly function organs

38. Shock
Hemodynamic Evaluation and monitoring
CVP, PWAP, arterial line, U.C.
Prognosis: Septic shock has a high mortality
rate ( death rate) exceeding 50%
Complications: Prompt treatment of bacterial
infection is helpful, other causes cannot be
prevented.
Multiorgan failure, respiratory, cardiac, and
others

39. Shock
Neurogenic shock
Definition
In neurogenic shock there is paralysis of
vasomotor system (sympathetic drive fibers)
leading to decrease peripherals resistance and
pooling of blood leading to inadequate venous
return

40. Shock
Causes
Spinal cord injuries
Vasovagal attack due to severe trauma or
stimulus.
Mechanism: Extensive vasodilatation of GI vessels
(splanchnic) de crease resistance
decrease venous return decrease blood
supply to the organ
Increase vagal stimulus to the heart leads to
bradycardia decrease HR. Decrease
cardiac output shock
0

41. Shock
Treatment
Shock position
IV crystalloid
Vasopressor – may be given

42. Shock
Endocrine shock
Definition
Shock occurs in patients receiving cortisone
therapy if they subjected to stressful conditions
(infection or surgery)

43. Shock
Mechanism:
Adrenal cortex are already suppressed by cortisone
therapy
During stressful conditions the patients can not
release more cortisone from the suppressed
adrenal cortex
This can lead to peripheral circulatory failure
Hyponatremia (Na) and hyperkalemia severe
shock