This topic covers the etiology, types, pathogenesis and management of Hypovolemic & Septic Shock. It is very important for MBBS Students both theoritical and clinical aspect. Also they should know the hemodynamics of the above both types of Shock.....

1. Prof. U. Murali.
Shock
[Hypovolemic | Septic]

2. Learning Objectives
• Definition & Types
• Hypovolemic Shock
• Causes
• Pathogenesis
• Clinical Features
• Diagnosis
• Treatment
• Septic Shock
• Organisms + RF
• Pathogenesis
• Clinical Features
• Management

3. • Shock is a systemic state of low tissue
perfusion that is inadequate for
normal cellular respiration.
• It is either reduced oxygen delivery
(or) poor oxygen utilization (or)
increased oxygen consumption with
circulatory failure (collapse) and poor
perfusion.
• With insufficient delivery of oxygen
and glucose, cells switch from aerobic
to anaerobic metabolism.
• If perfusion is not restored in a timely
fashion, cell death ensues.
Definition

6. Hypovolemic Shock
Prof. U.Murali.

10. Hypovolemic Shock

11. Classification – H S

12. Investigation – H S

13. Treatment – H S

14. Septic Shock
Prof. U.Murali.

17. • Septic shock is a medical condition because
of severe infection and sepsis though the
microbe may be systemic or localized to a
particular site.
• This is the most common type of distributive
shock. It is considered as part of a spectrum
and a progression of SIRS (systemic
inflammatory response syndrome).
• Its most common victims are children,
immunocompromised individuals and the
elderly, as their immune systems cannot deal
with the infection as effectively as those of
healthy adults.
• The mortality rate from septic shock is
approximately 25-50%.
Septic Shock

18. • Septic shock may be due to gram-
positive organisms, gram negative
organisms, fungi, viruses or protozoa!
• Of the Bacteria’s involved - Gram –ve
bacteria ⅔ & Gram +ve ⅓.
• Gram-negative septic shock is called
as Endotoxic shock. It occurs due to
gram-neg bacterial infections –
commonly seen in strangulated
intestines, peritonitis, GIF, biliary &
urinary infections, major surgical
wounds, diabetic & crush wounds.
S S – Organisms

19. 19
S S – Risk Factors

20. S S – Pathogenesis

21. Septic Shock

23. S S – Pathogenesis

24. S S – Stages

25. 25

26. 26

27. 27

28. S S – Investigations

29. S S – Treatment

30. 30

31. • Definition & Types of Shock.
• Aetiology of Hypovolemic & Septic Shock.
• Pathophysiology of both types of Shock.
• Organisms & Risk factors of Septic shock.
• Clinical features of both types of Shock.
• Classification of Hypovolemic Shock due to Blood loss.
• Stages of Septic Shock.
• Investigations & Treatment of Hypovolemic & Septic Shock.
To Summarize

32. References

33. • Define shock.
• Illustrate with flow-chart the pathophysiology of HS & SS.
• Classify Haemorrhagic shock.
• Mention the clinical features of Hypovolemic shock.
• Describe the management of Hypovolemic shock.
• Enumerate the risk factors of Septic shock.
• Explain the stages of Septic shock.
• Write the algorithm of Septic shock.
Question Time

34. Which of the following is the last to occur in
septic shock? –
◼ a) Tachypnoea.
◼ b) Hypotension.
◼ c) Coronary artery hypoperfusion.
◼ d) Renal hypoperfusion.
◼

35. Which of the following causes of shock is not
actually caused by hypovolemia? –
◼ a) Shock during administration of spinal anesthesia.
◼ b) Shock following trauma.
◼ c) Shock following a large burn.
◼ d) Shock in prolonged intestinal obstruction.
◼

36. An 81-year-old female resident of a nursing home presents to the ED with
altered mental status. She is febrile to 39.5°C, hypotensive with a
widened pulse pressure, tachycardiac with warm extremities. Categorize
the type of shock in the above patient –
◼ a) Anaphylactic shock.
◼ b) Hypovolemic shock.
◼ c) Cardiogenic shock.
◼ d) Septic shock.
◼

37. A 65-year-old male patient with history of HTN and DM presents to the ER
with abrupt onset of diffuse abdominal pain with radiation to his low back.
O/E, the patient is hypotensive, tachycardic, afebrile with cool but dry skin.
Categorize the type of shock in the above patient –
◼ a) Obstructive shock.
◼ b) Hypovolemic shock.
◼ c) Cardiogenic shock.
◼ d) Distributive shock.
◼

38. A patient presents with hypotension and clinical features of septic shock.
Despite insertion of a CVP line the resident doctor is unclear whether the
patient’s hypotension is caused by hypovolemia (or) by sepsis-induced
myocardial depression [MD]. Which of the following statements is true? –
◼ a) An IV fluid must not be given unless MD is absolutely excluded.
◼ b) The resident should rapidly administer 500 ml of fluid to differentiate
between hypovolemia & MD.
◼ c) The resident should first raise the pressor support & see if the patient
responds.
◼ d) MD is not a component of septic shock, and the resident should only
treat for hypovolemia.

39. Which of the following is the correct physiological
change during hypovolemic shock? –
◼ a) Increased cardiac output.
◼ b) Decreased vascular resistance.
◼ c) Decreased venous pressure.
◼ d) Increased venous saturation.
◼

40. A patient who is experiencing hypovolemic shock has decreased
cardiac output, which contributes to ineffective tissue perfusion. The
decrease in cardiac output occurs due to –
◼ a) An increase in cardiac preload.
◼ b) An increase in stroke volume.
◼ c) A decrease in cardiac preload.
◼ d) A decrease in cardiac contractility.
◼

41. THANK YOU
THANK YOU . . .