Shock

Shock is a life threatening situation due to poor tissue perfusion with impaired cellular metabolism, manifested in turn by serious pathophysiology abnormalities.

1. Shock ManagementShock
Michael Kino
MBBS,NEIGRIHMS

2. What is Shock?
•Shock is the “physiologic state characterized by significant
reduction of systemic tissue perfusion, resulting in decreased
tissue oxygen delivery.”
•Tissue perfusion is dependent on systemic vascular resistance (SVR)
and cardiac output (COP).
•Imbalance between oxygen delivery and oxygen consumption which
leads to cell death, end organ damage, multi-system organ failure, and
death

3. Types of Shock
•Hypovolemic shock
•Traumatic shock
•Cardiogenic shock
Intrinsic
Compressive
•Distributive shock
Septic shock
Anaphylactic shock
Neurogenic shock
Hypoadrenalshock
•Obstructive shock

4. 1) Cardiogenic Shock
•Shock caused as a result of cardiac pump failure
•Results in a decrease in capillary osmotic
pressure(COP)
•Systemic vascular resistance(SVR) is increased in an
effort to compensate to maintain organ perfusion
•Causes:
•Myocardial Infarction
•Arrythmias (Atrial fibrillation, ventricular
tachycardia, bradycardia, etc.)
•Mechanical abnormalities (valvular defects)
•Extracardiac abnormalities (PE, pulmonary HTN,
tension pneumothorax)

5. Pathophysiology of Cardiogenic Shock
Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.

6. Treatment of Cardiogenic Shock
•Fluid is not routinely advised
•Inotropic or Vasopressor support:
•Dobutamine
•Norepinephrine
•Dopamine
•Epinephrine
•Oxygenation
•If MI –Aspirin, Heparin, and Revascularization
•If arrythmia –correct arrythmia
•If extracardiac abnormality –reverse or treat cause

7. 2) Hypovolemic Shock
•Shock caused by decreased preload due to
intravascular volume loss (1/5 of blood volume)
•Results in decreased COP
•SVR is typically increased in an effort to
compensate
•Causes:
•Hemorrhagic –( trauma, GI bleed, hemorrhagic
pancreatitis, fractures)
•Fluid loss induced –(Diarrhea, vomiting, burns)

8. Pathophysiology of Hypovolemic Shock
Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.

9. #Treatment of Hypovolemic Shock
•Maximize oxygen delivery
•Control further blood loss
•Tourniquets
•Surgical intervention
•Fluid resuscitation
•NS fluid boluses
•Blood product administration

10. 3) Distributive Shock
•Shock as a result of severely diminished SVR
•COP is typically increased in an effort to
maintain perfusion
•Subtypes:
a) Septic –secondary to an overwhelming infection
b) Anaphylactic –secondary to a life-threatening allergic
reaction
c) Neurogenic –secondary to a sudden loss of the
autonomic nervous system function

11. #Treatment of Septic Shock
•Resuscitate
•30cc/kg of NS bolus
•Identify Source
•Pan cultures
•CT scan
•Line removal
•Foley removal
•Surgical exploration
•Antibiotics

12. #Treatment of Anaphylactic Shock
•Remove offending agent
•Establish an airway and return circulation
•Pharmacologic support:
•Epinephrine –reverses peripheral vasodilation, dilates bronchial
airways, increases myocardial contractility, and suppresses histamine/
leukotriene release
•Antihistamine--may help counter histamine-mediated vasodilation
and bronchoconstriction
•Corticosteroids (hydrocortisone) –may help shorten reaction
•Bronchodilators

13. Neurogenic Shock
•Hemodynamic phenomenon that can occur within
30 minutes of a spinal cord injury at the fifth
thoracic (T5) vertebra or above and can last up to 6
weeks
•Results in massive vasodilation leading to pooling of
blood in vessels

14. Pathophysiology of Neurogenic Shock
Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.

15. #Treatment of Neurogenic Shock
•Establish an airway to maintain adequate
oxygenation and ventilation
•Fluid resuscitation for mean arterial
pressure(MAP)>65mmHg
•Inotropic support
Dobutamine
Dopamine
•Atropine for severe bradycardia
•High dose methylprednisolone therapy

16. All three types of shock can occur
at the same time to have a
combined shock picture.

17. Take the massage
Survival and outcomes improve with early
perfusion, adequate oxygenation, and
identification with appropriate treatment of the
cause of shock.