Shock

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1.

Definition of
Shock

Inadequate Perfusion and oxygenation of cells
leads to:
- Cellular dysfunction and damage
- Stimulation of inflammatory and antiinflammatory cascades
- Organ dysfunction and damge

2.

Prognosis of
Shock

High Mortality rate - 20-90%
Early intervention reduces mortality.
35-60% of patients die withing one month of
onset of septic shock, higher with cardiogenic
shock (60-90%).

3.

4 Types of
Shock

Cardiogenic
Obstructive
Hypovolemic
Distributive

Causes of
Cardiogenic
Shock

- Decreased contractility (MI, myocarditis,
cardiomyopathy, post resuscitation syndrome
after cardiac arrest).
- Mechanical dysfunction (papillary muscle
rupture post MI, severe aortic stenosis, rupture
of ventricular aneurysms)
- Arrhythmias (Heart block, ventricular tach,
SVT, Afib, etc.)
- Cardiotoxicity (BB, CCB overdoses)

4.

5.

Cardiogenic
Shock

Inadequate circulation of blood to the body as
a result of pump failure of some sort.

6.

Obstructive
Shock

Physical obstruction of the great vessels or of
the heart itself.

7.

Causes of
Obstructive
Shock

Heart functions, but a block to outflow occurs:
- Massive pulmonary embolism
- Aortic Dissection
- Cardiac tamponade
- Tension pneumothorax
- Vena cava syndrome (neoplasms,
ganulomatous disease)
- Sickle cell splenic sequestration

8.

Hypovolemic
Shock

Heart pumps and functions normally, but there
is not enough blood volume, mainly blood
plamsa, to adequately carry oxygen.

9.

Causes of
Hypovolemic
Shock

Decreased intravascular volume (preload) leads
to decreased stroke volume.
- Hemorrhagic - trauma, GI bleed, AAA rupture,
ectopic pregnancy.
- Hypovolemic - Burns, GI losses, dehydration,
third spacing (pancreatitis, bowel obstruction),
adesonian crisis, diabetic ketoacidosis.

10.

Distributive
Shock

Heart Pumps and functions normally, but there
is peripheral vasodilation due to loss of vessel
tone. A result of hypovolemia.

11.

Causes of
Distributive
Shock

Loss of Vessel Tone
- Sepsis and Toxic Shock Syndrome
- Anaphylaxis
- Post resuscitation syndomre following cardiac
arrest.
Decreased sympathetic nervous system
function.
- Neurogenic - C Spine or upper thoracic
injuries
Toxins
- Due to cellular poisons (Carbon monoxide,
methemoglobinemia, cyanide)
- Drug overdoes (a1 antagonists)

12.

Types of
Shock

13.

Stages of
Shock

1.
2.
3.
4.
5.

14.

Powerpoint

Shock-Final in ClinMed Seminars

15.

Pathogenesis
of Sepsis

Organism --> systemic inflammation or
inflammatory response --> Diffuse endothelial
disruption and microcirculation defects -->
Global tissue hypoxia and organ dysfunction -> Severe sepsis --> Multiple organ dysfunction
and refractory hypotension --> Septic shock

16.

Sepsis

Sysetmic inflammatory response syndrome
(SIRS) with 2 or more or:
- Temp > 100.4 or < 96.8
- RR >20
- HR > 90/min
- WBC >12,000 or <6,000 or more than 10%
Bands (Bands = Bad)
- BP may be normal

Insult/damage/trauma
Preshock (Compensation)
Shock (Compensation overwhelmed)
End Organ Damage
Death

Plus proven or suspected microbial source.
17.

Stages of
Sepsis

SIRS
Sepsis
Severe Sepsis
Septic Shock
Multiple organ dysfunction syndrome
(MODS)/Death

18.

Risk Factors
for Sepsis

Extremes of age
Immunocompramised patients
Sickle cell disease
Disrupted barriers