Shock

Presented by
Dr. Faiza Naeem
Definition
• Shock is characterized by systemic hypoperfusion of tissues which is
caused by diminished cardiac output or by reduced circulating blood
volume.
OR

• Shock is a physiologic state characterized by systemic reduction in

tissue perfusion, resulting in decreased tissue oxygen delivery
TYPES OF SHOCK

SHOCK

CARDIOGENIC HYPOVOLEMIC NEUROGENIC

SEPTIC SHOCK
SHOCK SHOCK SHOCK
SYMPTOMS
TYPE SYMPTOMS
ETIOLOGY
PATHOGENESIS
1. INFLAMMATORY MEDIATORS
PAMPS, PGs, IL
(Pathogen associated molecular patterns)

COMPLEMENT CASCADE

PRODUCTION OF C3a, C5a

Pro inflammation
PATHOGENESIS
2. ENDOTHELIAL CELL ACTIVATION AND INJURY
THROMBOSIS, VASODILATION, INCREASED VASCULAR PERMEABILITY

PRODUCTION OF ENDOTHELIAL ANTI COAGULANTS

(Protein C,thrombomodulin) IS REDUCED

INCREASDED PRO COAGULANTS

DECREASED BLOOD FLOW (STASIS)

HYPOPERFUSION
PATHOGENESIS
3. METABOLIC ABNORMALITY
HYPERGLYCEMIA

SUPPRESS NEUTROPHIL FUNCTION

DECREASING BACTERICIDAL ACTIVITY

INCREASED ADHESION MOLECULE EXPRESSION

ON ENDOTHELIAL CELLS

SEPSIS
PATHOGENESIS
4. IMMUNE SUPPRESSION
SEPSIS

HYPERINFLAMMATORY STATE

IMMUNOSUPPRESSION
PATHOGENESIS
5. ORGAN DYSFUNCTION
• SYSTEMIC HYPOTENSION
• INCREASED VASCULAR PERMEABILITY
• ENDOTHELIAL INJURY IN PULMONARY CIRCULATION

• ARDS (ACUTE RESPIRATORY DISTRESS SYNDROME)

PATHOGENESIS
STAGES
• Initial Non-progressive:(compensated stage)
Attempt to correct the metabolic upset of shock.

• Progressive: (decompensated stage )

Eventually the compensation will begin to fail.

• irreversible (Refractory) :
Organs fail and the shock can no longer be reversed.
• Maintain A B C Airway Breathing Circulation
• Provide
normal saline,
Ringer lactate,
blood transfusion
• Dobutamine