1

Shock

Types of Shock :
• 1. Hypovolemic
• 2. Septic
• 3. Cardiogenic
• 4. Neurogenic
• 5. Anaphylactic
• Other classification of Shock
• 1.Hypovolemic
• 2. Cardiogenic
• 3. Obstructive
• cardiac tamponade, tension pneumothorax, massive pulmonary embolus and air embolus).
• 4. Distributive
• ( septic shock, anaphylaxis neurogenicand spinal cord injury ).
• 5. Endocrine
• ( hypo- and hyperthyroidism and adrenal insufficiency).


Pathophysiology :

• Adrenal -- () Catecholamine

2. Kidney --- () Aldosterone

3. pituitary-- () ( ADH) ,ACTH

• Cell - Anaerobic respiration - decrease cell

• Activity—
• Acidosis -decrease sodium/potassium pumps
• AT-Pase--
• Adrenal ----catechlamine s
• ( A&NA) ---
• Adrenal---
• Aldosterone--- Cortisone (ACTH)
• Kidney–
• Ars—ADH ---Aldosterone
• increased sympathetic activity and release of catecholamines ( A&NA)
• Pituitary–
• ADH---ACTH
• Respiratory Alkalosis


10 A

Ischaemia–reperfusion syndrome

Multiple organ failure

Table Effects of organ failure

• Lung Acute respiratory distress syndrome
• Kidney Acute renal insufficiency
• Liver Acute liver insufficiency
• Clotting Coagulopathy
• Cardiac Cardiovascular failure

Monitoring for patients in shock

1- Minimum
■ Electrocardiogram
■ Pulse oximetry
■ Blood pressure
■ Urine output


2- Additional modalities
■ Central venous pressure
■ Invasive blood pressure
■ Cardiac output
■ Base deficit and serum lactate

RESUSCITATION

Immediate resuscitation maneuvers for patients presenting in shock are to ensure a patent airway and adequate oxygenation and ventilation.

Once ‘airway’ and ‘breathing’ are assessed and controlled, attention is directed to cardiovascular resuscitation.

• Hypovolemic shock :

Is characterized by a loss of circulating volume.
blood, plasma, fluid.

C.F

Rx

2. Cardiogenic shock :

Is due to in adequate heart pump.


Etiology
Intrinsic
extrinsic

Clinical manif .
Treatment

3. Septic shock

It is G –ve septicemia & toxemia

Predisposing factors

DM, Alcoholism, steroid & cytotoxic therapy.

C.P
• Early septic shock (High cardiac out put)
• Low cardiac out put
• Treatment

4.Neurogenic shock

d.t sympathetic tone interruption B.P, SVR, PR, warm, dry skin. Pink
e.g spinal cord transaction

Treatment
•


Vasovagal shock
d.t  tone of Vagus nerve --- HR B.P VR C.O.P
d.t sudden sever pain or sever emotional reaction.

Rx

5. Anaphylactic shock

d.t pencillins, others Dextran, Serum, Stings.

Ag combined with Ig E on the mast cells

Rx: 3A

hypovolemic

cardiogenic

obstructive

distributive


Cardiac output
low
low
low
high
Vascular resistance
High
high
high
low
Venous pressure
low
high
high
low
Mixed venous saturation
low
low
low
high
Base deficit
high
high
high
high
Cardiovascular and metabolic characteristics of shock


Clinical features of shock

Compensated

Mild

Moderate

Severe
Lactic acidosis
+
++
++
+++
Urine output
Normal
Normal

Reduced

Anuric
Level of consciousness
Normal


Mild anxiety
Drowsy
Comatosed
Respiratory rate
Normal

increased

increased
laboured
Pulse rate
Mild increase
increased
increased

increased

Blood pressure
Normal

Normal

Mild hypotension
Severe hypotension