Typese mechanism stages management of shock

Best ppt for 1st year mbbs students for a crisp about mechanism and types of shock

1. Shock
And it’s pathophysiology

2. Shock
And it’s pathophysiology
Rajnish singh(93)
Rashi dewangan(94)
Renuka nag(95)
Rishabh bhoi(96)

3. Table of Contents

01
Physiology of
shock
02
Stages of shock
03
Types of shock
04
Treatment of shock
05
Summary and Quiz

4. Introduction and causes
Physiology of shock
01

7. What is “shock” ?
Reduced tissue perfusion resulting in
inadequate oxygen and nutrient
supply, and leading to tissue damage,
if untreated.

8. CIRCULATORY SHOCK

9. CIRCULATORY SHOCK
Perfusion is the means by which
blood provides nutrients and
removes cellular waste.
Adequate tissue perfusion-when
supply meets demand-is
necessary to maintain healthy
vital tissue. 
Perfusion is the blood flow at the capillary level in
tissue.

10. CIRCULATORY SHOCK
Circulatory shock means
generalized inadequate
blood flow through the body
to the extent that the body
tissues are damaged,
especially because too little
oxygen and other nutrients
are delivered to the tissue
cells.

11. Even the cardiovascular system itself—the heart musculature, walls of the
blood vessels, vasomotor system, and other circulatory parts—begins to
deteriorate, so the shock, once begun, is prone to become progressively
worse.
CIRCULATORY SHOCK

13. PHYSIOLOGICAL CAUSES OF
SHOCK
Decreased cardiac output
Any condition that reduces the cardiac output far below normal may lead to
circulatory shock.
1. Cardiac abnormalities that decrease the ability of the heart to pump blood.
These abnormalities include in particular myocardial infarction but also toxic states
of the heart, severe heart valve dysfunction, heart arrhythmias, and other
conditions.
The circulatory shock that results from diminished cardiac pumping ability is called
cardiogenic shock.

14. as many as 70 percent
of people who experience
cardiogenic shock do not
survive.

15. PHYSIOLOGICAL CAUSES
OF SHOCK
2. Factors the decrease venous return also decrease cardiac output because
the heart cannot pump the blood that doesn’t flow into it.
The most common cause of decreased venous return is diminished blood
volume, but venous return can also be reduced as a result of decreased
vascular tone.
Especially of venous blood reservoirs, or obstruction to blood flow at some
point in the circulation , especially in the venous return pathway to the heart

16. Shock without diminished cardiac output
Occasionally, cardiac output is normal or even
greater than normal, yet the person is in a state
of circulatory shock. It is due to:
1.Excessive metabolic rate, so even a normal
cardiac output is inadequate .
2.Abnormal tissue perfusion patterns, so most
of the cardiac output is passing through
blood vessels other than those that supply
the local tissue with nutrition

17. END RESULT OF SHOCK

18. END RESULT OF SHOCK

19. Circulatory Shock

20. WHAT HAPPENS TO THE ARTERIAL
PRESSURE IN CIRCULATORY SHOCK?

21. ARTERIAL
PRESSURE

22. WHAT HAPPENS TO THE ARTERIAL
PRESSURE IN CIRCULATORY SHOCK?
In most types of shock, especially shock caused by severe blood
loss, the arterial blood pressure decreases at the same time the
cardiac output decreases, although usually not as much.
However it can often be misleading !

A person may be in severe shock and still have an almost normal arterial
pressure because of powerful nervous reflexes that keep the pressure
from falling.
Also, the arterial pressure can fall to half of normal but the person still
has normal tissue perfusion and is not in shock.

23. SHOCK CAUSED BY HYPOVOLEMIA —
HEMORRHAGIC SHOCK
Hypovolemia means diminished blood volume.
Hemorrhage is the most common cause of hypovolemic shock.
Hemorrhage decreases the filling pressure of the circulation and,
as a consequence, decreases venous return. As a result, the
cardiac output falls below normal and shock may ensue.

24. RELATIONSHIP OF BLEEDING VOLUME TO
CARDIAC OUTPUT AND ARTERIAL PRESSURE

25. RELATIONSHIP OF BLEEDING VOLUME TO
CARDIAC OUTPUT AND ARTERIAL PRESSURE
Amount of blood
removed from
circulatory system
Bleeding volume
Total blood
volume pumped
by heart
Cardiac output
Mean value of
systolic and
diastolic pressure
Arterial pressure

26. 30 min

29. SYMPATHETIC NERVOUS REFLEXES
These reflexes stimulate the sympathetic vasoconstrictor system
in most tissues of the body, resulting in three important effects:
1. The arterioles constrict in most parts of the systemic circulation,
thereby increasing the total peripheral resistance.
2. The veins and venous reservoirs constrict, thereby helping to
maintain adequate venous return despite diminished blood volume.
3. Heart activity increases markedly, sometimes increasing the heart
rate from the normal value of 72 beats/min to as high as 160 to 180
beats/min.

30. SYMPATHETIC NERVOUS REFLEXES
In the absence of the sympathetic
reflexes,
Only 15 to 20 percent of the blood
volume can be removed over a period of
30 minutes before a person dies; in
contrast,
a person can sustain a 30 to 40 percent
loss of blood volume when the reflexes
are intact.

31. SYMPATHETIC NERVOUS REFLEXES
Therefore, the reflexes extend the
amount of blood loss that can
occur without causing death to
about twice that which is possible
in their absence.

32. SYMPATHETIC NERVOUS REFLEXES

33. SYMPATHETIC NERVOUS REFLEXES

34. SYMPATHETIC NERVOUS REFLEXES
The reason for this difference is that the sympathetic reflexes are geared
more for maintaining arterial pressure than for maintaining cardiac
output.
They increase the arterial pressure mainly by increasing the total
peripheral resistance, which has no beneficial effect on cardiac output
however, the sympathetic constriction of the veins is important to keep
venous return and cardiac output from falling too much, in addition to
their role in maintaining arterial pressure.

35. SYMPATHETIC NERVOUS REFLEXES

36. SYMPATHETIC NERVOUS REFLEXES

37. SYMPATHETIC NERVOUS REFLEXES
Especially interesting is the second plateau occurring at about 50
mm Hg in the arterial pressure curve.
This second plateau results from activation of the central nervous
system ischemic response, which causes extreme stimulation of
the sympathetic nervous system when the brain begins to
experience lack of oxygen or excess buildup of carbon dioxide.
This effect of the central nervous system ischemic response can
be called the “last-ditch stand” of the sympathetic reflexes in their
attempt to keep the arterial pressure from falling too low.

38. PROTECTION OF CORONARY AND CEREBRAL
BLOOD FLOW BY THE REFLXES
No significant
constriction, blood flow
auto-regulate itself
excellently,despite the
fact that others areas
have significant blood
flow decrease
Brain
Maintained at
normal levels as
long as the
arterial pressure
does not fall
below about 70
mmHg
Heart

A

B
A
B

39. And their mechanism
Stages of shock
02

40. Stages of shock
Non-progressive
stage
Progressive
stage
Irreversible
stage
Is divided into 3
major stages
Shock

01
02
03

41. NONPROGRESSIVE SHOCK
Sometimes called the compensated stage, in which the normal
circulatory compensatory mechanism eventually cause full
recovery without help from outside therapy
Sympathetic reflexes and other factors compensate enough to
prevent further deterioration of circulation
The factors that cause a person to recover from moderate
degree of shock are all NEGATIVE FEEDBACK mechanisms that
attempt to return CARDIAC OUTPUT and ARTERIAL
PRESSURE to normal levels

42. NONPROGRESSIVE SHOCK
Baroreceptor reflex

43. 01 02 03 04
Cerebral
ischemia
Sympathetic
activity
Vasomotor
centre
Arterial
pressure
Central nervous system ishcemic response
Activated when arterial pressure falls below 50 mmHg
NONPROGRESSIVE SHOCK

44. NONPROGRESSIVE SHOCK
reverse stress relaxation of circulatory system
Causes the blood vessels to contract around the diminished
blood volume so that the blood volume that is available more
adequately fills the circulation

45. NONPROGRESSIVE SHOCK
RAAS mechanism
Which constrict the peripheral arterioles and also caused
decreased output of water and salt by the kidneys, which
ultimately increase blood volume

46. NONPROGRESSIVE SHOCK
increased secretion of ADH from posterior pituitary
Which constrict the peripheral arterioles and veins ,and greatly
increased water retention by kidneys

47. NONPROGRESSIVE SHOCK
increased secretion by
adrenal medullae of
EPINEPHRINE AND
NOREPINEPHRINE
Which constrict the
peripheral arterioles and
veins ,and greatly
increases heart rate

48. NONPROGRESSIVE SHOCK
Compensatory mechanisms that return
the blood volume back toward normal.
Absorption of large quantities of fluid
from the intestinal tract.
Absorption of fluid into the blood
capillaries from the interstitial spaces
of the body.

49. Conservation of water and salt
by the kidneys.
Increased thirst and increased
appetite for salt, which make the
person drink water and eat salty
foods if they are able to do so.

50. The sympathetic reflexes and increased secretion of.
catecholamines by the adrenal medullae provide rapid
help toward bringing about recovery because they
become maximally activated within 30 seconds to a few
minutes after hemorrhage.
The angiotensin and vasopressin mechanisms, as well
as the reverse stress-relaxation that causes contraction
of the blood vessels and venous reservoirs, all require
10 minutes to 1 hour to respond completely

51. Finally, readjustment of blood volume by
absorption of fluid from the interstitial
spaces and intestinal tract, as well as
oral ingestion
Absorption of additional quantities of
water and salt, may require from 1 to 48
hours, but recovery eventually takes
place, provided the shock does not
become severe enough to enter the
progressive stage.

52. When the arterial pressure falls low enough ,
coronary blood flow decreases below that required
for adequate nutrition of the myocardium, weakening
the heart muscle and decreasing the cardiac output
more.
Thus , a positive feedback cycle develops, whereby
the shock becomes more and more severe.
PROGRESSIVE STAGE

53. It leads to progressive deterioration of the
heart.
In early stages, it is not severe during the
first hour of shock.
In last stages of shock, however,
deterioration of the heart is probably the
most important factor in the final lethal
progression of shock.
CARDIAC DEPRESSION

54. In early stages, circulatory reflex and
sympathetic nervous system helps prevent
decreased arterial pressure.
However , there comes a point when
diminished blood flow to the brain’s
Vasomotor center depresses the center so
much that it, too, become progressively less
active and finally totally inactive.
VASOMOTOR FAILURE

55. VASOMOTOR FAILURE

56. —Guyton uncle
“Fortunately, the Vasomotor center usually
does not fail in the early stages of shock if
the arterial pressure remains above 30
mmHg”

57. BLOCKAGE OF VERY SMALL VESSELS

58. INCREASED CAPILLARY PERMEABILITY
many hours
of hypoxia
lack of
nutrients
permeability of
capillaries
increases
fluid begin to
transude into
tissues
Blood volume
decrease

59. RELEASE OF TOXINS BY ISCHEMIC TISSUE

60. RELEASE OF TOXINS BY ISCHEMIC TISSUE

61. CARDIAC DEPRESSION CAUSED BY ENDOTOXIN

62. GENERALISED CELLULAR DETERIORATION

63. GENERALISED CELLULAR DETERIORATION
mitochondrial
activity is
diminished

64. GENERALISED CELLULAR DETERIORATION
Cellular metabolism is depressed

65. GENERALISED CELLULAR DETERIORATION
Na-K pumps are
diminished

66. GENERALISED CELLULAR DETERIORATION
lysosome breaks open

67. ACIDOSIS IN SHOCK

68. POSITIVE FEEDBACK( VICIOUS CYCLE )
Each degree of shock causes a further
increase in the shock.
In severe degrees of shock, deteriorating
feedback mechanism become more and
more powerful leading to rapid deterioration
of circulation that all the negative feedback
systems of circulation acting together
cannot return the cardiac output to normal.

69. Any therapy becomes incapable of
saving the person’s life. :(
IRREVERSIBLE SHOCK

70. BLOOD TRANSFUSION

72. so much tissue damage has occurred
so many destructive enzymes have been released into
the body fluids
so much acidosis has developed
so many other destructive factors are now in progress
that even a normal cardiac output for a few minutes
cannot reverse the continuing deterioration

73. DEPLETION OF CELLULAR HIGH ENERGY PHOSPHATE RESERVES
IN IRREVERSIBLE SHOCK
No more new
ATP can be
generated, as
they are
difficult to
replenish

74. Therefore, in severe shock, a stage is
eventually reached at which the person will
die even though vigorous therapy might still
return the CO to normal for short periods

75. —Mr bean
“Operation was successful,
but the patient died”

76. Pathology
Mercury is the
closest planet
to the Sun
Mercury
It’s composed
of hydrogen
and helium
Saturn
Despite being
red, Mars is a
cold place
Mars
It’s the biggest
planet in the
Solar System
Jupiter

77. Concepts and Typology
Concept Typology Features
Type A Mars Jupiter Venus
Type B Saturn Mercury Neptune

78. A Picture is Worth
a Thousand Words

79. Risk Factors
Despite being red,
Mars is a cold
place
Mars
It’s the biggest
planet of them all
Jupiter
To modify this graph, click on it, follow the link,
change the data and paste the new graph here

80. 200,000,000
Big numbers catch your
audience’s attention

81. Key Numbers
50,000
Mars is actually a cold place full
of iron oxide dust
20,000
Jupiter is a gas giant and also
the biggest planet
5,500
Saturn is composed mostly of
hydrogen and helium

82. Diagnosis
Mercury
Mercury is the closest
planet to the Sun
Venus
Venus is the second planet
from the Sun
Mars
Despite being red, Mars is
actually a cold place
Jupiter
It’s the biggest planet in the
Solar System
Saturn
Saturn is composed of
hydrogen and helium
Neptune
Neptune is the farthest
planet from the Sun

83. Venus has a beautiful
name and is the second
planet from the Sun
Treatment
Venus
Mercury is the closest
planet to the Sun and
the smallest one
Mercury

84. ●You can describe here what
the patient shouldn’t do
●You can describe here what
the patient shouldn’t do
●You can describe here what
the patient shouldn’t do
Recommendations
What not to do
●You can describe here what
the patient should do
●You can describe here what
the patient should do
●You can describe here what
the patient should do
What to do

X

V

85. Prevalence
01
Despite being red,
Mars is a cold
place
Mars
It’s the biggest
planet of them all
Jupiter
02
02
01

86. Mercury is the closest planet
to the Sun and the smallest
one in the Solar System—it’s
only a bit larger than the Moon
Healthy Habits

87. Jupiter is a gas giant, the
biggest planet in the Solar
System and the fourth-
brightest object in the night sky
Conclusions

88. You can replace the
image on the screen
with your own one
You can replace the
image on the screen
with your own one
Dr. John James
Our Team
Dr. Jenna Doe

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