This document defines and describes the different types of shock: 1) Hypovolemic shock occurs when there is severe bleeding, fluid loss, or reduced circulating blood volume leading to decreased cardiac output and blood flow. 2) Cardiogenic shock results from heart failure or damage that prevents the heart from pumping effectively. 3) Septic shock is caused by an overwhelming systemic infection where toxic substances impair blood flow. 4) Anaphylactic shock involves an allergic reaction that causes blood vessel dilation and low blood pressure through histamine release.

1. Pre by lect : MR ZAHID REHMAN
IPMS(KMU)

2. Inadequate oxygen delivery to meet metabolic
demands
Shock is a state of physical shutdown. In this
condition there is not enough circulating
blood. Shock can cause multiple organ
failure. It can lead to life-threatening
complications, such as heart failure

3. Profound hemodyamic and metabolic
disturbance characterized by failure of the
circulatory system to maintain adequate
perfusion of vital organs.
Inadequate perfusion and oxygenation of
cells leads to:
• Cellular dysfunction and damage
• Organ dysfunction and damage

4. Pathophysiology: of shock
 Tissue perfusion is determined by Mean Arterial
Pressure (MAP)
MAP = CO x SVR*o2 content in the blood
Heart rate Stroke Volume

5. 1.Neurogenic Shock
Injury or trauma to the nervous system
(spinal cord, brain). Nerve impulse to
blood vessels impaired, blood vessels
remain dilated and blood pressure
decreases.

6. • Occurs after acute spinal cord injury
• Sympathetic outflow is disrupted leaving
unopposed vagal tone
• Results in hypotension and bradycardia
• Spinal shock- temporary loss of spinal reflex
activity below a total or near total spinal cord
injury (not the same as neurogenic shock, the
terms are not interchangeable)

7. • Loss of sympathetic tone results in warm and dry
skin
• Shock usually lasts from 1 to 3 weeks
• Any injury above T1 can disrupt the entire
sympathetic system
• Higher injuries = worse paralysis
MPA= CO*SVR decrease

8. Cardiogenic Shock
Myocardial Infarction with damage to heart
muscle; heart unable to pump effectively.
Inadequate cardiac output. Body cells do
not receive enough oxygen.

9. Myocardial Injury or Obstruction to Flow
• Arrythymias
• valvular lesions
• AMI
• Severe CHF
• Hypertrophic Cardiomyopathy

10. Pulmonary Embolism
Cardiac Tamponade
Tension Pneumothorax

11.  Heart fails to pump blood out
MAP = CO x SVR
HR Stroke Volume

12. Normal
MAP=CO*SVR Cardiogenic
Shock
MAP = ↓CO
x SVR
MAP = ↓CO x
↑ SVR
↓MAP = ↓↓CO x ↑ SVR

13. Severe bleeding or loss of body fluid from
trauma, burns, surgery, or dehydration
from severe nausea and vomiting. Blood
pressure decreases, thus blood flow is
reduced to cells, tissue, and organs
OR
Reduced circulating blood volume with
secondary decreased cardiac output

14. Non-hemorrhagic
Vomiting
Diarrhea
Bowel obstruction, pancreatitis
Burns
 environmental (dehydration)

15. Hemorrhagic
GI bleed
Trauma
Massive hemoptysis
AAA rupture
Ectopic pregnancy, post-partum
bleeding

16.  Heart pumps well, but not enough blood volume to pump
MAP = CO x SVR
HR x Stroke volume

17. Normal
MAP = CO x SVR
Hypovolemic
MAP = ↓CO x
SVR
MAP = ↓CO
x ↑ SVR
↓MAP = ↓↓CO x ↑ SVR

18. When the blood flow decrease the
resistance of the blood vessel increase to
response the body constrict the blood
vessel cause vasoconstriction due to
sympathatic tone of vessel.
Due to increase the resistance of vessel the
blood flow squeese towards the heart,
mostly happened in the venous drainage.
Sympathetic tone also act on the heart to
increased the heart rate.

19. An acute infection, usually systemic, that
overwhelms the body (toxic shock
symdrome). Poisonous substances
accumulate in bloodstream and blood
pressure decreases, impairing blood flow
to cells, tissues, and organs.

21.  Clinical signs:
 Hyperthermia or hypothermia
 Tachycardia
 Wide pulse pressure
 Low blood pressure (SBP<90)
 Mental status changes
 Beware of compensated shock!
 Blood pressure may be “normal”

23. Results from reaction to substance to
which patient is hypersensitive or allergic
(allergen extracts, bee sting, medication,
food). Outpouring of histamine results in
dilation of blood vessels throughout the
body.

24. Anaphylactic shock have two types:
1. Immonulogical anaphylactic shock
2. Non immonulogical anaphylactic shock
Firs the allergen ( from food, bees and toxin)
interect with the B cell (creating
antibody). Antibody react against the
allergen.
IgE immunglobin activated and attached to
mast cell ( mediated immune system).
Mast cell activated immune mediated

25. Mast communicate with other WBCS to
recruited in the allergy side. Both mast cell
and immune system activated and release
histamine, dilated the blood vessel.
Increase the diameter of blood vessel
decrease the BP and also fluid escape
from the vessel cause swelling and
edema.
2. Non immunological respone:
Allergen specifically attached to the

26. Heart pumps well, but there is peripheral
vasodilation due to loss of vessel tone
MAP = CO x SVR
HR x Stroke volume

27. Normal
MAP = CO x SVR
Anaphylactic
MAP = co x ↓ SVR
MAP =
↑co x ↓ SVR
↓MAP = ↑co x ↓↓ SVR

28. 6.Psychogenic Shock
Shock caused by overwhelming emotional
factors. Sudden dilation of blood vessels
results in fainting because of lack of blood
supply to the brain.

29. 7.Respiratory Shock
Trauma to the respiratory tract (trachea,
lungs) that causes a reduction of oxygen
and carbon dioxide exchange. Body cells
cannot receive enough oxygen.

30.  decrease in blood pressure
 rapid, weak, or absent pulse
 irregular heart rate
 confusion
 rapid and shallow breathing
 anxiety
 decrease in urine
 chest pain
 nausea
 thirst and dry mouth
 low blood sugar
 fever (septic shock only)
 hives and swelling of the face and throat
(anaphylactic shock only)

31.  Anything that affects the flow of blood through
the body can cause shock. Some common
causes of shock are:
 significant blood loss
 dehydration
 allergic reaction
 reduced blood pressure
 heart failure
 nerve damage
 blood infections

32. Hypovolemic shock is usually treated by
blood transfusion.
Shock caused by dehydration is treated
with IV fluids.
Shock caused by anaphylaxis is treated
with epinephrine and other drugs.
Cardiogenic shock is treated by improving
blood flow through to the heart.

33. THANK YOU