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1. shock 10/2/2025 Prepared by surgical students 1

2. outline Objectives Introduction Definition Etiology Risk factors Pathophysiology Stages of shock Types of shock Clinical manifestation Diagnosis Nursing and Medical Management Treatment Complication 10/2/2025 Prepared by surgical students 2

3. Objectives After completion of this presentation, the student will be able to describe: Types and causes of shock. Define shock and state the pathophysiological classification of shock. Describe the pathways leading to shock and decreased tissue perfusion. Discuss the stages of a hypovolemic shock. Explain how stage III hypovolemic shock might result in major organs failure. Discuss the different compensatory mechanisms during a hypovolemic shock. Describe the positive feedback mechanisms in the irreversible stage of a hypovolemic shock. 10/2/2025 Prepared by surgical students 3

4. Introduction Shock is a life-threatening condition that leads to global tissue hypoperfusion and circulatory collapse. Shock affects all body systems. It may develop rapidly or slowly, depending on the underlying cause. Septic shock causes highest rates of mortality (40–60%), compared to other types of shock. There is no one specific vital sign that is diagnostic of shock . Shock management requires securing airway, controlling breathing, and optimizing circulation to ensure adequate tissue perfusion Mortality is high without early diagnosis and treatment. 10/2/2025 Prepared by surgical students 4

5. SHOCK DEFINITION: It is a clinical syndrome of circulatory failure that result in reduced blood flow to vital body organs and tissues which leads to inadequate Tissue perfusion and damage . The cell is the basic unit of life and it needs oxygen to produce energy. Adequate blood flow to the tissues and cells requires: an effective cardiac pump, adequate vasculature or circulatory system, and sufficient blood volume. No oxygen → No energy → No life Shock is a life-threatening condition that requires immediate and intensive treatment. 10/2/2025 Prepared by surgical students 5

6. contd. ............. Circulatory shock : When the circulatory system is unable to provide adequate circulation & tissue perfusion → decreased availability of oxygen and nutrients → failure to deliver oxygen to the tissues & vital body organs relative to its metabolic requirement → cellular hypoxia and energy deficit . Result: organ dysfunction and cellular damage. (not death) If not quickly corrected: whole body failure à leads to irreversible shock and death The circulatory shock characterized by: hypotension. inadequate tissue perfusion ( decrease delivery of o2 and nutrients to the critical organs in body as brain ,heart ….etc ) . low cardiac out put. 10/2/2025 Prepared by surgical students 6

7. Pathophysiology of Shock Reduce capillary perfusion → Inadequate tissue oxygen → Shift to anaerobic metabolism → Metabolic acidosis → Release of free radical and oxidative stress - Reactive Oxygen Species(ROS) → Tissue damage → Apoptosis(programed cell death) 10/2/2025 Prepared by surgical students 7

8. Etiology Heart conditions (heart attack, heart failure) Heavy internal or external bleeding, such as from a serious injury or rupture of a blood vessel Dehydration, especially when severe or related to heat illness. Infection (septic shock) Severe allergic reaction (anaphylactic shock) Spinal injuries (neurogenic shock) Burns Persistent vomiting or  diarrhea 10/2/2025 Prepared by surgical students 8

9. contd. ............. Regardless of the initial cause of shock, certain physiologic responses are common to all types of shock. These physiologic responses include: hypoperfusion of tissues, hypermetabolism, and activation of the inflammatory response The body responds to shock states by activating the sympathetic nervous system and mounting a hypermetabolic and inflammatory response. Failure of compensatory mechanisms to effectively restore physiologic balance is the final pathway of all shock states and results in end-organ dysfunction and death. 10/2/2025 Prepared by surgical students 9

10. Risk factors Old age History of heart disease Obesity Chronic diseases like DM,HTN… Hematoma Major surgeries Catheterization 10/2/2025 Prepared by surgical students 10

11. Pathophysiology Shock results from a change in one or a combination of the following: intravascular volume, myocardial function, systemic vascular resistance, or distribution of blood flow. 10/2/2025 Prepared by surgical students 11

12. Stages of shock clinical picture compesatorystage progressivestage irreversiblestage Bp Normal systolic<80-90mmhg require mechanical or pharmacological support pulse >100b/m >150b/m erratic systole RR >20 c/m rapid ,shallow respiration require intubation skin cold, clammy mottled jaundice UOP Decrease 0.5ml/h anuria mental status Confusion lethargy unconscious pupils normal(2-4mm)dilated normal size or dilated dilated 10/2/2025 Prepared by surgical students 12

13. Classification of Shock 1- Hypovolemic shock . blood volume problem 2- Cardiogenic shock . blood pump problem 3- Distibutive shock (vasogenic shock) blood distrubtion problem include: -Aseptic shock -Neurogenic shock -Anaphylactic shock 4-Obstructive shock. blood out flow problem 10/2/2025 Prepared by surgical students 13

14. 1. Hypovolemic Shock Hypovolemic shock is an emergency condition in which severe blood or other fluid loss makes the heart unable to pump enough blood to the body. The most common type of shock, is characterized by a decreased intravascular volume .heart pump well ,but no enough blood volume to pump.  Causes: 1-blood loss through(internal or external hemorrhage) 2-plasma loss through(burns) 3-fluids loss through: severe vomiting and diarrhea. excessive sweating . renal problems or excessive use of diuretics(Polyuria). inadequate fluid intake. Severe edemas or ascities 10/2/2025 Prepared by surgical students 14

15. Pathophysiology 10/2/2025 Prepared by surgical students 15 The sequence of events in hypovolemic shock begins with adecrease in the intravascular volume. This results in decreased venous return of blood to the heart and subsequent decreased ventricular filling. Decreased ventricular filling results in decreased stroke volume (amount of blood ejected from the heart) and decreased cardiac output. When cardiac output drops, blood pressure drops and tissues cannot be adequately perfused

16. Clinical Features of Hypovolemic Shock ▹ Pale (due to hypoperfusion). ▹ Cold clammy skin (due to hypoperfusion). ▹ Sustained Hypotension (< 85/40 mmHg for 30 mins) ▹ Weak, rapid pulse (140/min) ▹ Tachycardia (sensed by baroreceptors in compensation to the ↓ MAP). ▹ Increased respiratory rate (sensed by chemoreceptors in compensation for hypoxia). ▹ Increased thirst ▹ Oliguria (low urine output) / Anuria (no urine output). ▹ Metabolic acidosis ▹ Restlessness (due to hypoperfusion). ▹ Blood test: lactic acidosis. 10/2/2025 Prepared by surgical students 16

17. Treatment Medical Management 1 Replacement therapy(blood and plasma transfusion ) Fluid Replacement Crystalloids 0.9% sodium chloride (normal saline solution) Lactated Ringer’s Hypertonic saline (3%, 5%, 7.5%) Colloids Albumin (5%, 25%) Dextran (40, 70) ,Interferes with platelet aggregation; not recommended for hemorrhagic shock Hetastarch 10/2/2025 Prepared by surgical students 17

18. 2- oxygenation through facial mask and nasal catheter. 3- corticosteroide ( hydrocortisone IV ) 4- Pharmacological agents as: a- Antiemetic (Domperidone) if the loss of fluid resultant from vomiting. b- inotropic agent ( dopamine ) c- analgesic ( pethidine 50-100mg IV ) 5- frequent monitoring of (VS, UOP, Central venous pressure (CVP)) until complete recovery. Note: the normal range of CVP is 8-12 cm of water, it is low in hypovolemic shock 10/2/2025 Prepared by surgical students 18

19. Nursing Management positioning the patient properly assists fluid redistribution. A modified Trendelenburg position is recommended in hypovolemic shock. Elevating the legs promotes the return of venous blood. Administering blood transfusions safely. administering Oxygen ( to increase the amount of oxygen carried by available hemoglobin in the blood). monitors the patient closely for cardiovascular overload and pulmonary edema. Hemodynamic pressure, vital signs, arterial blood gases, hemoglobin and hematocrit levels, and fluid intake and output are among the parameters monitored. 10/2/2025 Prepared by surgical students 19

20. 2. Cardiogenic Shock Cardiogenic shock occurs when the heart’s ability to contract and to pump blood is impaired and the supply of oxygen is inadequate for the heart and tissues. Inadequate tissue perfusion resulting directly from myocardial dysfunction. It happens when the heart is damaged and unable to supply sufficient blood to the body. 10/2/2025 Prepared by surgical students 20

21. Pathophysiology cardiogenic shock involves a vicious spiral circle: ischemia causes myocardial dysfunction, which in turn aggravates myocardial ischemia. Myocardial stunning and/or hibernating myocardium can enhance myocardial dysfunction, thus, worsening the cardiogenic shock 10/2/2025 Prepared by surgical students 21

22. Etiology The causes of cardiogenic shock are known as either coronary or noncoronary . Non-coronary Factors Cardiomyopathies Valvular damage Cardiac tamponade Dysrhythmias pulmonary embolism Drugs toxicity 10/2/2025 Prepared by surgical students 22 coronary : Inefficient cardiac contraction as in: a)MI b)Severe arrhythmias c)Sever spinal anesthesia

23.  Clinical manifestation Hypotension Neck veins congested (JVP = Jugular Venous Pressure is raised) CVP is high Dysrhythmia Cold, sweaty and dusky skin Low cardiac out put Tachycardia Mental impairment(confusion and agitation) Angina pain. 10/2/2025 Prepared by surgical students 23

24. TREATMENT First-line treatment of cardiogenic shock involves the following actions: Supplying supplemental oxygen Controlling chest pain Providing selected fluid support Administering vasoactive medications Controlling heart rate with medication or by implementation of atransthoracic or intravenous pacemaker Implementing mechanical cardiac support (intra-aortic balloon counterpulsation therapy). 10/2/2025 Prepared by surgical students 24

25. PHARMACOLOGIC THERAPY morphine sulfate: to control chest pain Dobutamine (Dobutrex) : produces inotropic effects by stimulating myocardial beta receptors, increasing the strength of myocardial activity and improving cardiac output. Nitroglycerin: causes arterial vasodilation and therefore reduces afterload as well. Dopamine (Intropin) Other Vasoactive Medications include: norepinephrine (Levophed) , epinephrine (Adrenalin) , milrinone (Primacor) , amrinone (Inocor) , vasopressin (Pitressin) , and phenylephrine (Neo-Synephrine) . Fluid Therapy 10/2/2025 Prepared by surgical students 25

26. MECHANICAL ASSISTIVE DEVICES The goals of intra - aortic balloon counter - pulsation include the following: Increased stroke volume Improved coronary artery perfusion Decreased preload Decreased cardiac workload Decreased myocardial oxygen demand 10/2/2025 Prepared by surgical students 26

27. Nursing Management O2 administration monitoring the patient’s hemodynamic and cardiac status. administration of intravenous fluids and medications. documents and records medications and treatments that are administered as well as the patient’s response to treatment. safeguarding the patient, enhancing comfort, and reducing anxiety. Proper positioning of the patient promotes effective breathing without decreasing blood pressure 10/2/2025 Prepared by surgical students 27

28. 3-Distributive shock medical condition in which abnormal distribution of blood flow in the smallest blood vessels results in inadequate supply of blood to the body tissues and organs . Distributive shock or vasodilatory shock is a medical emergency where the body can’t get enough blood to the heart, brain and kidneys due to dilation of the blood vessels. There are 3 types of distributive shock Anaphylactic shock Septic shock Neurogenic shock 10/2/2025 Prepared by surgical students 28

29. A)Septic shock Septic shock is the most common type of circulatory shock and is caused by widespread infection . it is a form of shock that occurs in septicemia when endotoxins or exotoxins are released from certain bacteria in the Blood stream. Or it is shock resulting from over whelming infection causing relative hypovolemia. Nosocomial infections (infections occurring in the hospital) in critically ill patients most frequently originate in the blood stream, lungs, and urinary tract. 10/2/2025 Prepared by surgical students 29

30. pathophysiology of septic shock Septic shock results when infectious microorganisms in the bloodstream induce aprofound inflammatory response causing hemodynamic decompensation. The pathogenesis involves acomplex response of cellular activation that triggers the release of a multitude of proinflammatory mediators. 10/2/2025 Prepared by surgical students 30

31. contid.................... This inflammatory response causes activation of leukocytes and endothelial cells, as well as activation of the coagulation system. The excessive inflammatory response that characterizes septic shock is driven primarily by the cytokines tumor necrosis factor alpha (TNF-α) and interleukin-1 (IL-1), which are produced by monocytes in response to an infection . 10/2/2025 Prepared by surgical students 31

32.  Causes 1)Causative organisms as: a)Gram negative bacilli. b)Staphylococci. c)Candida. 2)Infections as: a)Peritonitis caused by spread of infection from: i.Gentaile organs ii.Unsterile instrumental abortion iii.Rupture of GIT by intestinal disease and wound b)Infection spread to blood from (kidney or UT) c)Generalized body infection as skin infection d)Generalized gangrenous infection 10/2/2025 Prepared by surgical students 32

33.  Risks factors 1)Suppress immune system by: a)Extremes of ages (< 1 year and > 65 years) b)Chronic illness (DM, AIDS) c)Corticosteroids and chemotherapy d)Malignancy e)Malnutrition 2)Invasive procedure ( IV infusion, catheter ). 10/2/2025 Prepared by surgical students 33

34. C linical manifestation High fever may reach to 40 Chills Hypotension Tachycardia Tachypnea Warm dry skin Confusion Oliguria 10/2/2025 Prepared by surgical students 34

35. Medical Management Current treatment of septic shock involves identifying and eliminating the cause of infection. Any potential routes of infection must be eliminated. Intravenous lines are removed and reinserted at other body sites. Antibiotic-coated intravenous central lines may be placed to decrease the risk of invasive line-related bacteremia in high-risk patients, such as the elderly . Fluid replacement must be instituted to correct the hypo_x0002_volemia that results from the incompetent vasculature and in-flammatory response. Crystalloids( normal saline ,ringer lactate ) colloids, and blood products may be administered to increase the intravascular volume. 10/2/2025 Prepared by surgical students 35

36. PHARMACOLOGIC THERAPY If the infecting organism is unknown, broad-spectrum antibiotic agents are started until culture and sensitivity reports are received . A third-generation cephalosporin( like, ceftriaxone , ciprofloxacillin, ceftazidime) plus an aminoglycoside may be prescribed initially. Medications (inotropes as dopamine to support cardiac contractility and cardiac output and vasopressors as adrenaline if present hypotension. Corticosteroids( hydrocortisone,dexamethasone) Antibiotics as combination of [cephalosporin, aminoglycoside and metronidazole] 10/2/2025 Prepared by surgical students 36

37. NUTRITIONAL THERAPY Early Enteral Nutrition: Early initiation of enteral nutrition (feeding through the gut) is preferred over parenteral nutrition (feeding through intravenous route) in patients with septic shock, as it helps maintain gut integrity and function. It also reduces the risk of infections and improves outcomes. Adequate Protein Intake: Protein is essential for immune function and tissue repair. Patients with septic shock may have increased protein requirements due to the hypermetabolic state and catabolic response. Micronutrient Supplementation: Supplementation with vitamins such as vitamin C, vitamin D, and minerals like zinc and selenium may be beneficial in supporting immune function and reducing oxidative stress. Caloric Support: Providing adequate caloric support is important to prevent malnutrition and support recovery 10/2/2025 Prepared by surgical students 37

38. Nursing Management administers prescribed intravenous fluids and medications, including antibiotic agents and vasoactive medications to restore vascular volume. Frequent monitoring of (vital signs, urine output, CVP, ABG, and ECG). the nurse monitors blood levels (BUN, creatinine, white blood count) and reports increased levels to the physician. monitors the patient’s hemodynamic status, fluid intake and output, and nutritional status. Daily weights and close monitoring of serum albumin levels help determine the patient’s protein requirements. 10/2/2025 Prepared by surgical students 38

39. B)NEUROGENIC SHOCK It is the shock state resulting from loss of vasomotor sympathetic tone and causing relative hypovolemia Neurogenic shock is extremely dangerous because it can cause the   blood pressure to drop  drastically and suddenly, and can leave irreversible damage to the body tissues. 10/2/2025 Prepared by surgical students 39

40. Pathophysiology of neurogenic shock In neurogenic shock, there is a sudden loss of sympathetic nervous system activity, leading to vasodilation and a decrease in systemic vascular resistance. This results in a pooling of blood in the peripheral vessels, leading to decreased venous return and cardiac output. As a result, blood pressure drops, and there is inadequate perfusion to vital organs, potentially leading to organ dysfunction and failure. 10/2/2025 Prepared by surgical students 40

41. Causes 1) Vaso-vagal attack due to: a)Hearing bad news or watching unpleasant event b)Trauma c)Braine ischemia for few minutes excessive vagal stimulation hypotension d)Severe pain and fear 2)High transection of spinal cord due to: a)Spinal fracture or spinal cord injury b)As a complication of high spinal anesthesia (Both causes vasomotor sympathetic paralysis hypotension) 3)Deep general anesthesia (Depress vasomotor causes vasomotor paralysis neurogenic shock) 4)Braine damage often causes vasomotor paralysis (As Brain concussion or contusion of the basal region of Brain develops profound neurogenic shock) 5)Glucose deficiency 6)Depressed action of medication 10/2/2025 Prepared by surgical students 41

42. Clinical manifestation Flaccid paralysis Absence of reflexes Hypotension Bradycardia Paralytic ileus Loss of temperature regulation Warm dry skin Moist skin 10/2/2025 Prepared by surgical students 42

43. Treatment Medical Management Specific treatment of neurogenic shock depends on its cause. If hypoglycemia (insulin shock) is the cause, glucose is rapidly administered. If bradycardia is present, interventions such as atropine. Replacement therapy: ringer lactate Vasopressor drugs epinephrine or norepinephrine Surgery treatment 10/2/2025 Prepared by surgical students 43

44. Nursing Management Position the patient should lies in flat with elevation of the legs to increase venous return Ensure Airway, Breathing, and Circulation (ABCs) Monitor vital signs closely, including blood pressure, heart rate, and oxygen saturation. Assist with fluid resuscitation as ordered by the healthcare provider. Monitor fluid intake and output closely to assess for fluid balance and signs of fluid overload. Administering heparin or low-molecular-weight heparin (Lovenox) as prescribed, to prevent DVT. 10/2/2025 Prepared by surgical students 44

45. contid.................. Perform frequent neurological assessments to monitor changes in level of consciousness, motor function, sensory function, and reflexes. Document any changes or deterioration in neurological status. Implement measures to prevent pressure ulcers, such as turning and repositioning the patient regularly, using pressure-relieving devices, and maintaining skin hygiene. Educate the patient and family about neurogenic shock, its causes, symptoms, treatment options, and potential complications. 10/2/2025 Prepared by surgical students 45

46. C)Anaphylactic shock Is caused by severe allergic reaction when a patient who has already produced antibodies to a foreign substance (antigen) develops a systemic antigen- antibody reaction . An antigen–antibody reaction provokes mast cells to release potent vasoactive substances, such as histamine or bradykinin , that cause widespread vasodilation and capillary permeability It is a life threatening systemic hypersensitivity reaction contact with an allergen and it is occurs rapidly. It causes blood pressure to drop and narrows the airway,then making breathing difficult. 10/2/2025 Prepared by surgical students 46

47. Pathophysiology of anaphylactic shock allergen , drug, etc antigen antibody reaction vasodilation capillary permeability severe broncho constriction decreased oxygen supply and utilization inadequate tissue perfusion 10/2/2025 Prepared by surgical students 47

48. Causes Drugs sensitivity (antibiotic like, penicillin and anesthetic drugs ) transfusion reaction Bee sting allergy Latex sensitivity Severe allergy to some type of food(fish or eggs) 10/2/2025 Prepared by surgical students 48

49. Clinical manifestation 1. Skin Symptoms: Itching, hives (urticaria), redness, or flushing of the skin Swelling of the face, lips, tongue, or throat (angioedema) Generalized skin rash 2. Respiratory Symptoms: Shortness of breath Wheezing or coughing Chest tightness or chest pain Stridor (high-pitched sound with breathing) Rapid or labored breathing 3. Cardiovascular Symptoms: Hypotension (low blood pressure) Weak or rapid pulse Palpitations Fainting or dizziness Cardiac arrest in severe cases 10/2/2025 Prepared by surgical students 49 4. Gastrointestinal Symptoms: Nausea, vomiting, or diarrhea Abdominal pain or cramping 5. Neurological Symptoms: Anxiety, confusion, or feeling of impending doom Headache Dizziness or lightheadedness 6. Other Symptoms: Feeling of warmth Metallic taste in the mouth Sense of impending doom

50. Treatment Medical Management In cases of anaphylactic shock, the primary treatment is the prompt administration of epinephrine (adrenaline) to counteract the severe allergic reaction. Epinephrine acts quickly to reverse the symptoms of anaphylaxis by constricting blood vessels, relaxing airway muscles, and increasing heart rate and blood pressure Antihistamine such as: Diphenhydramine (Benadryl) is administered to reverse the effects of histamine, thereby reducing capillary permeability. Beta adrenergic like albuterol (Proventil), may be given to reverse histamine-induced bronchospasm. 10/2/2025 Prepared by surgical students 50

51. contid............. If cardiac arrest and respiratory arrest are imminent or have occurred, cardiopulmonary resuscitation(CPR) is performed. Endotracheal intubation or tracheotomy may be necessary to establish an airway. Remove the causative antigen(eg, discontinuing an antibiotic agent), administering medications that restore vascular tone, and providing emergency support of basic life functions. O2 therapy Corticosteroid ( hydrocortisone IV) Replacement therapy IV 10/2/2025 Prepared by surgical students 51

52. Nursing Management assessing all patients for allergies or previous reactions to antigens (eg,medications, blood products, foods, contrast agents, latex) and communicating the existence of these allergies or reactions to others. assess the patient's airway, breathing, and circulation (ABCs). Monitor vital signs, including blood pressure, heart rate, respiratory rate, and oxygen saturation. Position the patient in a semi-Fowler's position to improve ventilation 10/2/2025 Prepared by surgical students 52

53. contid.................. Provide emotional support and reassurance to the patient and their family. Educate the patient about allergen avoidance. Document the patient's history, assessment findings, interventions, response to treatment, and vital signs in a clear and concise manner. Evaluate for skin changes, such as hives, flushing, or swelling. Administer supplemental oxygen to maintain adequate oxygenation. administering antihistamines (e.g., diphenhydramine) and corticosteroids to reduce inflammation and allergic symptoms Assess for signs of respiratory distress, such as wheezing, stridor, or decreased breath sounds. 10/2/2025 Prepared by surgical students 53

54. 4-Obstructive shock Is the circulatory shock resulting from obstruction of blood flow in cardiovascular circulate that characterized by either impairment of diastolic filling or excessive after load. A pulmonary embolism is one condition that may cause an interruption to blood flow. Conditions that can cause a buildup of air or fluid in the chest cavity can also lead to obstructive shock. 10/2/2025 Prepared by surgical students 54

55. Causes 1) Impaired diastolic filling(decrease ventricular preload) a)Direct venous obstruction(vena cava) Intrathoracic obstructive tumor b)Increased intrathoracic pressure i.Tension pneumothorax ii.Mechanical ventilation with(excessive pressure or volume depletion) iii.asthma c)Decreased cardiac compliance i.Constrictive pericarditis ii.Cardiac temponade 10/2/2025 Prepared by surgical students 55 2) Impaired systolic Contraction (increase ventricular afterload) a)In right ventricular i.Pulmonary embolus(massive) ii.Acute pulmonary hypertension b)In left ventricular i.Embolus ii.Aortic dissection

56.  Clinical Features 1)Skin: a)Pale, clammy skin. b)Excessive sweating. c)Cool fingers and toes. Kidneys: little or no urine output. 2)Brain: a)Confusion. b)Loss of ability to concentrate. c)Loss of consciousness. d)Lightheadedness. 3)Others: a)Tachycardia. b)Weak pulse. c)Chest pain. d)Rapid, shallow breathing. 10/2/2025 Prepared by surgical students 56

57. Treatment Treatment of underlying causes Relieve of obstruction is life saving Cardiac centesis in cardiac tamponed Thoracentesis in tension pneumothorax Thrombolysis in massive pulmonary embolus Surgical removal in tumor or in massive pulmonary embolus O2 therapy Replacement therapy Frequent monitoring of: Vital signs, ECG,CBC ,PTT and PT , O2 saturation 10/2/2025 Prepared by surgical students 57

58. DIAGNOSIS History collection Physical examination Blood culture and sensitivity test CBC-increased WBC and ESR level Arterial blood gas analysis – respiratory alkalosis ECG – dysarrythmia Echocardiogram – to rule out aortic stenosis and pulmonary embolism X-ray & CT scan 10/2/2025 Prepared by surgical students 58

59. COMPLICATION If the shock not treated early can lead to MOSF 1.Heart: mal distribution of blood flow. 2.Liver: hepatic dysfunction & jaundice. 3.Kidney : A.R.F (acute renal failure) 4.Lung: adult respiratory distress syndrome, hypoxia, respiratory failure & pneumonia. 5.G.I.T: stress ulceration bleeding (hematemesis + bleeding per rectum). 6.Endocrine: acute adrenaline failure. 7.Brain: cerebral ischemia + metabolic encephalopathy coma. 8.Metabolic : hyperglycemia & lactic acidosis. 10/2/2025 Prepared by surgical students 59

60. PREVENTION OF THE SHOCK Early and proper management of infection, Dehydration, Bleeding, Anemia, Malnutrition, tumor. Early detect and treated of any condition can lead to shock as patient with cardiac diseases. Proper monitoring of patient condition during anesthesia and pre -operative and pot- operative period (amount of blood loss, asepsis, vital signs and serum of electrolytes). Performing allergic testing before administration antibiotic drugs (AST). Proper control of severe pain by appropriate analgesic. 10/2/2025 Prepared by surgical students 60

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