Shock

Describes in brief about etiology, pathophysiology and management of shock

1. Shock Dr. L Vasavi reddy

2. Introduction

3. Definition

4. Classification:

5. Hinshaw and Cox Classification

6. HYPOVOLEMIC SHOCK The severity of clinical features depends upon degree of blood volume lost, hemorrhagic shock is divided into 4 types: < 1000 ml: Compensated 1000-1500 ml: Mild 1500-2000 ml: Moderate >2000 ml: Severe ETI0LOGY

7. CARDIOGENIC SHOCK Cardiogenic shock (CS) is characterized by systemic hypoperfusion due to severe depression of the cardiac index [<2.2 (L/min)/m2] and sustained systolic arterial hypotension (<90 mmHg), despite an elevated filling pressure [pulmonary capillary wedge pressure (PCWP) > 18 mmHg ETI0LOGY

8. ETI0LOGY

9. Distributive shock: Occurs when after load is excessively reduced ETI0LOGY

10. PATHOGENISIS In general, all forms of shock involve following 3 derangements: Reduced effective circulating blood volume. Reduced supply of oxygen to the cells and tissues with resultant anoxia. Inflammatory mediators and toxins released from shock induced cellular injury. These derangements initially set in compensatory mechanisms (discussed below) but eventually a vicious cycle of cell injury and severe cellular dysfunction lead to breakdown of organ function

11. PATHOGENESIS OF CARDIOGENIC SHOCK

12. Pathophysiology of septic shock

13. Pathophysiology (Stages of Shock)

14. Compensatory responses All compensatory responses to shock, whether hemodynamic, metabolic or biochemical, support oxygen delivery to vital organs. These responses are similar for varying classes of shock and are divided into four categories): (a) Maintenance of mean circulatory pressure (b) Maximizing cardiac function (c) Redistributing perfusion to vital organs (d) Optimizing unloading of oxygen at tissues

15. Diagnostic Approach and Evaluation A monitored physiologic approach to therapy provides the best opportunity for successful outcome and avoidance of organ dysfunction.

16. Signs and symptoms Tachycardia, tachypnea and oliguria are the hall mark. Cool extremities are seen in hypodynamic shock. With progression, blood pressure falls and frank hypotension

17. Management: Patients in shock should be managed in ICU with continuous ECG monitoring and close nursing support .

18. Specific therapies