SHOCK.pptx. .

Shock. .

1. - THE SHOCK

2. WHAT IS SHOCK? Shock is defined as a state of cellular and tissue hypoxia due to either reduced oxygen delivery, increased oxygen consumption, inadequate oxygen utilization, or a combination of these processes. It is a critical medication condition characterized by inadequate blood flow and oxygen and tissues. It can result from various underlying cause and leads to cellular dysfunction and potentially life threatening consequences. The effects of shock are initially reversible, but rapidly become irreversible, resulting in multiorgan failure (MOF) and death. 

3. Classification OF SHOCK: Classification by initiating mechanism: HYPOVOLEMIC SHOCK: CARDIOGENIC SHOCK: DISTRIBUTIVE SHOCK: OBSTRUCTIVE SHOCK:

4. 1. Hypovolemic shock: It refers to a medical condition in which rapid fluid loss results in multiple organ failure due to inadequate circulating volume and subsequent inadequate perfusion. 2. Cardiogenic shock: It is  a life-threatening condition in which your heart suddenly can't pump enough blood to meet your body's needs . 3. Distributive shock: It is a life threatening event that results from lack of adequate blood flow and blood pressure throughout the body, and loss of blood volume through capillary leakage. 4.Obstructive shock: There is a reduction in pre load due to mechanical obstruction of cardiac filling.

5. AETIOLOGY OF SHOCK: CAUSES OF HYPOVOLEMIC SHOCK: Hemorrhagic cause and non-hemorrhagic cause ( includes dehydration, vomiting, diarrhea, urinary loss as in diabetes) CAUSES OF CARDIOGENIC SHOCK: Myocardial infarction, Cardiac dysthymias, valvular heart disease, blunt myocardial injury. CAUSES OF DISTRIBUTIVE SHOCK: Sepsis ( Bacterial infection), Anaphylaxis ( Allergic reaction), Neurogenic (spinal cord injury)

6. Pathogenesis of shock: Stages of shock: 1. Initial phase: Here the cardiac output tends to decrease, causing an impairment of tissue perfusion. 2 .Compensatory phase: The compensatory phase is the stage where the body alters its hemodynamic function to compensate for the poor tissue perfusion. This stage is characterized by compensatory mechanisms with increased sympathetic tone resulting in; increased heart rate, increased cardiac contractility, peripheral vasoconstriction and the body begins to retain sodium and water. As the stage progresses, the cells of the body switch from aerobic to anaerobic metabolism to compensate for the poor tissue perfusion which results in lactic acidosis. In an attempt to blow off the effects of lactic acidosis ,the glucose levels rise and the pulmonary respiratory rate increases These changes set the stage for the progressive phase.

7. PATHOGENESIS OF SHOCK: 3.Progressive phase: The progressive phase is characterized by the beginning of the failure of the compensatory phase to bring back the body back to equilibrium. In this phase the cells are functioning on anaerobic metabolism which does not produce enough energy to sustain cellular life and cells begin to die. Those cells that survive begins to see a failure of their sodium-potassium pumps which causes cell swelling. 4.Refractory phase: If left unchecked the progressive phase can cycle into the refractory phase which is characterized by multiorgan failure which may lead to death.

8. PATHOPHYSIOLOGY OF SHOCK: 1. HYPOVOLEMIC SHOCK : It is due to reduced circulatory volume. It is probably the most common form of shock and to some degree is the component of all other forms of shock. Absolute or relative hypovolemia must be excluded or treated in management of shock state regarding of cause. 2.CARDIOGENIC SHOCK: It is due to primary failure of heart to pump blood to tissues. Cardiac insufficiency may be due to myocardial depression caused by endogenous or exogenous factors. Endogenous factors: Bacterial and humoral agents released in sepsis. Exogenous factors: Pharmaceutical agent and drug abuse.

9. Pathophysiology of shock: 3. OBSTRUCTIVE SHOCK: Reduction in pre load due to mechanical obstruction of cardiac filling. Reduced Cardiac output. 4. DISTRIBUTIVE SHOCK: Inadequate organ perfusion is accompanied by vascular dilation with hypotension, low systemic vascular resistance, inadequate after load, and a resulting abnormally high cardiac output.

10. DIAGNOSIS OF SHOCK: There are several types of shock, each with its own specific causes and diagnostic criteria 1. Hypovolemic Shock: Diagnosis is based on clinical evaluation, including symptoms such as rapid heart rate, low blood pressure, decreased urine output, cool and clammy skin, and altered mental status. Laboratory tests may show elevated blood lactate levels and signs of anemia or dehydration 2. Cardiogenic Shock: Diagnosis is based on symptoms such as low blood pressure, rapid heart rate, shortness of breath, and signs of poor organ perfusion. Diagnostic tests such as electrocardiography (ECG), echocardiography, and cardiac enzyme tests may be performed to evaluate heart function) 3. Obstructive Shock: Diagnosis involves assessing clinical symptoms, conducting imaging studies (e.g., chest X-ray, computed tomography), and other diagnostic tests to identify the underlying obstructive cause. 4.Distributive Shock: Diagnosis is based on clinical evaluation, including signs of vasodilation (e.g., warm skin, flushed appearance), rapid heart rate, and low blood pressure. For specific subtypes like septic shock, additional laboratory tests, blood cultures, and imaging studies may be performed

11. Clinical manifestation Depending on the cause, symptoms and signs of shock may include: The most common clinical features which are suggestive of shock include hypotension, tachycardia, tachypnea, obtundation or abnormal mental status, cold, clammy extremities, mottled skin, oliguria, metabolic acidosis, and hyperlactatemia. Patients with hypovolemic shock can have general features as mentioned above as well as evidence of orthostatic hypotension, pallor, flattened jugular venous pulsations, may have sequelae of chronic liver disease (in case of variceal bleeding). Patients with septic shock may present with symptoms suggestive of the source of infection (example-skin manifestations of primary infection such as erysipelas, cellulitis, necrotizing soft-tissue infections), and cutaneous manifestations of infective endocarditis. Patients with anaphylactic shock can have hypotension, flushing, urticaria, tachypnea, hoarseness of voice, oral and facial edema, hives, wheeze, inspiratory stridor, and history of exposure to common allergens such as medications or food items the patient is allergic to or insect stings.

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