Shock

1. Shock

2. What is Shock? Shock is defined as a condition in which systemic Blood Pressure is inadequate to deliver oxygen and nutrient to support vital organs and cellular function.

3. What are the Types of Shock? Hypovolemic Shock Cardiogenic shock Distributive shock Septic shock Anaphylactic shock Neurogenic Shock

4. What are the stages of Shock? Initial stage Compensatory stage Progressive stage Refractory stage

5. Pathophysiology Cardiac Output Tissue perfusion HR and contractility, arterial & venous vasoconstriction, shunting of blood to the vital organs 1. Initial Stage 2. Compensatory Stage a. Neural response

6. Activation of the Renin response Production of Angiotensin II Vasoconstriction & release of aldosterone & ADH release Sodium & water release b. Hormonal response

7. ii. Stimulation of anterior pituitary Secretes ACTH Stimulates adrenal cortex Release of glucocorticoids Blood glucose levels

8. iii. Stimulation of adrenal medulla Release of epinephrine & nor-epinephrine Failure to meet the tissue metabolic needs Activation of anaerobic metabolism 3. Progressive stage

9. Lactic acedemia Further decreased tissue perfusion Irreversible damage to cells Failure of Na ++ -K + Pump Mitochondria swells up and ruptures Death of cell

10. Clinical consequences MODS Irreversible shock Death 4. Refractory stage

11. What are the Consequences of shock? Cardiovascular Ventricular filure Microvascular thrombosis Neurologic SNS dysfunction Cardiac and respiratory depression Thermoregulatory failure Coma

12. Pulmonary Acute respiratory failure Acute lung injury Renal Acute tubular necrosis (ATN) Hematologic Disseminated Intravascular Coagulation (DIC) Gastro intestinal GIT failure Hepatic failure Pancreatic failure

13. What are the Diagnostic criteria for Shock? SBP less than 90 mm of Hg Tachycardia Altered Mental status Altered serum lactate and base levels

14. How do we manage Shock? Maintain patent airway Improve ventilation and oxygenation Vasoconstrictors – Epinphrine , nor-epinephrine Vasodilators- Nitroprusside , nitroglycerine Inotropes - Dobutamine , Epinphrine Antidysrrhythmics - Lidocaine , amiodarone

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