Introduction

Shock is the most common and therefore the most important cause of
death of surgical patients.
Death may occur rapidly due to a profound state of shock, or be
delayed due to the consequences of organ ischaemia and reperfusion
injury.
Shock

Shock is a systemic state of low tissue perfusion that is inadequate for

normal cellular respiration.
 With insufficient delivery of oxygen and glucose, cells switch from
aerobic to anaerobic metabolism.
 If perfusion is not restored in a timely fashion, cell death ensues.
Hypovolemic shock
Due to a reduced circulating fluid volume.
Haemorrhagic or non-haemorrhagic causes.
Haemorrhagic causes from injuries.(severe blood loss)
Non-haemorrhagic causes include dehydration, vomiting, diarrhoea,
urinary loss (e.g. diabetes).
most common form of shock.
Severity of shock
Clinical features of shock
Signs and
symptoms
Management
1. Resuscitation
• Assessment - Airway, Breathing and Circulation
• IV assess - Two wide bore cannulas
• IV fluid - Crystalloids (N.S or R.L)
• High flow oxygen
• Send blood for - Hb %, G and M, Urea and Electrolytes
• Cross match - At least 3 units of blood
• Blood transfusion - If massive bleeding or drop in Hb
2. Initial assessment
• Brief history taken from conscious patient or witness if the patient is
unconscious.
• Physical examination
• Estimation of apparent fluid loss
• Assessment of tissue perfusion(capillary refill time), cold and
clummy extremities
3. Monitoring
• Pulse • Pulse oximeter
• Heart rate and rhythm • Serum lactate
• BP
• Respiratory rate
• Hourly urine output
• Central venous pressure
• ECG
4. Treat the primary problem
5. Organ support
• Respiratory support – ventilation
• Renal support - dialysis
Thanks