SHOCK : CLASSIFICATION AND

PATHOPHYSIOLOGY
CONTENTS
• Definition

• Causes

• Classification

• Pathophsiology
DEFINITION
According to Bailey and Love,
“Shock is a life threatening situation due to poor
tissue perfusion with impaired cellular
metabolism, manifested in turn by serious
pathophysiological abnormalities.”
Inadequate Tissue Perfusion Can
Result In

Generalized cellular
hypoxia (starvation)

Widespread
impairment of
cellular metabolism

Tissue damage
organ failure
death
 CAUSES OF SHOCK
• HYPOVOLAEMIC SHOCK:

 Haemorrhage
 External from wounds, open fractures
 Internal from injury to spleen, liver, mesentery or
pelvis

 Severe burns, which results in loss of plasma

 Peritonitis, intestinal obstruction

 Vomiting and diarrhoea of any cause

• CARDIAC CAUSES:

• Acute myocardial infarction, acute carditis

• Acute pulmonary embolism wherein

embolus blocks the pulmonary artery at the
bifurcation or one of the major branches

• Drug induced

• Toxaemia of any causes

• cardiac surgical conditions like valvular

diseases, congenital heart diseases

• Cardiac compression causes

• Cardiac tamponade

• Trauma to heart
• SEPTIC SHOCK:
▫ Its due to bacterial infections which release toxins leading to shock

• NEUROGENIC SHOCK:
▫ Due to sudden to sudden anxious or painful stimuli causing severe
splanchnic vessel vasodilation.

• ANAPHYLACTIC SHOCK:
▫ Due to type 1 hypersensitivity reaction

• RESPIRATORY CAUSES :
▫ Atelectasis (collapse) of lung
▫ Thoracic injuries
▫ Tension pneumothorax
▫ Anesthetic complication

• OTHER CAUSES:
▫ Acute adrenal insufficiency (Addisons disease)
▫ myxoedema
 CLASSIFICATION 1

• Primary (INITIAL SHOCK)

• Secondary (TRUE SHOCK)

• Anaphylactic (Type I immunologic reaction)

• True shock- circulatory imbalance between oxygen

supply and oxygen requirements at cellular level;
hence name CIRCULATORY SHOCK.
 • According To Etiology: (harsh Mohan 4th edition)
▫ Hypovolemic shock
▫ Cardiogenic shock

▫ Septic shock

▫ Other types:

 Traumatic

 Neurogenic

 Hypoadrenal

• According To Davidson: (Davidson’s 21st ed)

Due to low flow(reduced stroke volume)

• hypovolemic
• cardiogenic
• obstructive

Due to low peripheral arteriolar resistance (vasodilatation)

• septic anaphylactic

• neurogenic
 • According To Bailey & Love’s short practice of surgery :
▫ Vasovagal
▫ Psychogenic
▫ Neurogenic
▫ Hypovolemic
▫ Traumatic
▫ Burns
▫ Cardiogenic
▫ Septic (endotoxin)
▫ Anaphylactic

• According to HINSHAW and COX (1972)

▫ Hypovolemic shock
▫ Cardiogenic shock
▫ Extra cardiac obstructive shock
▫ Distributive shock
▫ Septic shock
▫ Anaphylactic shock
▫ Neurogenic shock
• Shock due to reduced blood volume (Hypovolemic
shock or cold shock):
 Traumatic shock
 Hemorrhagic shock
 Surgical shock
 Burn shock
 Dehydration shock

• Shock due to increased vascular capacity:

 Neurogenic shock
 Anaphylactic shock
 Septic shock
 Shock due to diseases of the heart(cardiogenic shock)
 Shock due to obstruction of blood flow.
 PATHOPHYSIOLOGY OF SHOCK
Any cause of shock

Low cardiac output

Vasocostriction occurs as a compensation to perfuse vital organs like brain, heart, kidneys, liver

Because of vasoconstriction and tachycardia

Dynamic circulation increases

Tachypnoea occurs to increase the oxygen saturation

Peripheral veins constrict diverting blood from splanchnic system towards essential vital organs
 Decreased renal flow reduces the GFR and thereby reduces the urine output

Renin angiotensin mechanism gets activated causing further vasoconstriction and

aldosterone release

Causes salt and water retention

ADH is released

Further concentration of urine increases

Cardiac output falls leading to hypotension and tachycardia

Hypoxia- metabolic acidosis- release of cardiac depressants- CARDIAC FAILURE

 Hypoxia

Anaerobic metabolism- Lactic acidosis

Sodium and potassium enter the cell and potassium leaks out of the cell (causing hyperkalemia,
hyponatremia and hypocalcemia)

Intercellular lysosomes breakdown releasing powerful enzymes which destroy their own cells

SICKLE CELL SYNDROME

Platelets are activated forming small clots in many places

DISSEMINATED INTRAVASCULAR COAGULATION (DIC)

FURTHER BLEEDING