SHOCK BY ASAD ULLAH.pptx . . . . . . .

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1. SHOCK BY mr.ASAD ULLAH

2. SHOCK Shock is a state of physical shutdown. In this condition there is not enough circulating blood. Shock can cause multiple organ failure. It can lead to life threatening complications, such as heart failure. Inadequate perfusion and oxygenation of cells lead to: Cellular dysfunction and damage Organ dysfunction and damage

3. CAUSES OF SHOCK Blood loss Dehydration Allergic reaction Reduced blood pressure Heart failure Nerve damage Blood infection

4. TYPES OF SHOCK NEUROGENIC SHOCK injury or trauma to the nervous system ( spinal cord, brain). Nerve impulses to blood vessels impaired, blood vessel remain dilated and blood pressure decrease. Occurs after acute spinal cord injury Sympathetic outflow is disrupted leaving unopposed vagal tone

5. SYMPTOMS Chest pain (bronchoconstriction) Difficulty breathing Bradycardia Low blood pressure

6. CARDIOGENIC SHOCK Myocardial infarction with damage to heart muscle; heart unable to pump effectively. Inadequate cardiac output. Body cells do not receive enough oxygen. CAUSES Myocarditis Myocardial infarction Aortic valve stenosis Mitral valve stenosis Arrhythmia ( irregular heart beat)

7. INTRACARDIAC Myocardial injury or obstruction to flow Arrhythmia Valvular disease AMI Severe congestive heart failure Hypertrophic cardiomyopathy ( left ventricle muscle thick and stiff)

8. EXTRACARDIAC Pulmonary embolism Cardiac tamponade (fluid accumulate in the pericardial sac)

9. HYPOVOLUMIC SHOCK Severe bleeding or loss of body fluid from trauma, burns, surgery, or dehydration from severe nausea and vomiting. Blood pressure decreases, thus blood flow is reduced to cells, tissue, and organ. HEMORRHAGIC GI bleed Trauma hemoptysis Post partum bleeding

10. NON HEMORRHAGIC Vomiting Diarrhea Burns Dehydration (environmental)

11. SEPTIC SHOCK Septic shock is most common type of shock, caused by overwhelming systemic infection and inflammation resulting in vasodilation leading to hypotension. CAUSES Bacteria ( such as staph aureus, E. coli) Virus Fungi

12. HOW IT HAPPEN Immune inflammatory response begins to compete foreign organism Body release chemicals cytokines, complement factor, In septic shock these chemicals are not able to eliminate the foreign organism It actually cause itself damage The foreign organism itself release endotoxins and exotoxins Cause harm to organ

13. CLINICAL SIGNS Hyperthermia or hypothermia Tachycardia wide pulse pressure Low blood pressure

14. ANAPHYLACTIC SHOCK Is a severe allergic reaction to venom, food or medication most cases are caused by a bee sting or eating food that are known to cause allergies. Release of histamines caused widespread vasodilation leading to hypotension and increased capillary permeability. SIGNS AND SYMPTOMS OF ANAPHYLACTIC SHOCK Red skin rashes Swollen eyes, lips, hands, and feets Hypotension Dizziness or fainting Constriction of the air ways

15. RESPIRATORY SHOCK Trauma to the respiratory tract ( trachea or lungs) That cause a reduction of oxygen and carbon dioxide exchange. Body cells cannot receive enough oxygen

16. STAGES OF SHOCK Initial stage Tissue hypo perfusion ( hypoxia) ⇓ Due to lack of oxygen, mitochondria being unable to produce ATP, cell membrane become damaged ⇓ Cell perform anaerobic metabolism ⇓ Build-up of lactic and pyruvic acid ⇓ Systemic metabolic acidosis ⇓ Liver unable to remove these compounds due to absence of oxygen

17. Compensatory stage Body tries several mechanism to correct the anaerobic metabolism ⇓ Low arterial pressure and tissue perfusion activate compensatory mechanism to maintain perfusion to heart and brain ⇓ Hyperventilation will create respiratory alkalosis to neutralize the metabolic acidosis by maintaining the pH ⇓ Decrease BP stimulate baroreceptors in the carotid sinus and aortic arch, epinephrine and norepinephrine are secreted causing vasoconstriction, increasing BP and myocardial contractility ⇓ Low BP to kidney activate renin-angiotensin-aldosterone system , causing vasoconstriction, sodium and water retention, increase blood volume, blood pressure and venous return ⇓ Leading to increase heart rate and cardiac output

18. Progressive stage Compensatory mechanism fail to maintain cardiac output ⇓ Due to decrease tissue perfusion, capillary endothelium damages ⇓ Cell swell and its membrane become more permeable(increase cellular permeability) ⇓ Fluid leaks out of capillaries into the interstitial and there is sludging of blood ⇓ Decrease cardiac output and fall in BP, increase capillary permeability

19. Irreversible stage Vital organ have failed and the shock can no longer be reversed ⇓ Organ damage occurs as compensatory mechanism can no longer maintain cardiac output ⇓ reduced perfusion lead to cell death and release of lysosomal enzymes ⇓ Low perfusion to coronary arteries causing myocardial depression and a further reduction in cardiac output ⇓ Eventually circulatory and respiratory failure occurs ⇓ Brain damage and cell death occurs ⇓ Multiorgan failure or death

20. TREATMENT OF SHOCK Hypovolemic shock is usually treated by blood transfusion. Shock caused by dehydration is treated by IV fluids. Shock caused by anaphylaxis is treated with epinephrine and other drugs. Cardiogenic shock is treated by improving blood flow through to the heart