1. Dr. Abdullah M. Kaki, MB ChB, FRCPC
Shock
Dr. Abdullah M. Kaki, MB ChB, FRCPC
Department of Anesthesia, Faculty of Medicine, King Abdulaziz University

2. Objectives of the Lecture
To provide an up-to-date understanding of the types of shock
To understand the current pathophysiology of shock
To discuss some therapeutic options for shock

3. Definition French term , Choc (Le Dran- 1743)
Systemic derangement in tissue perfusion leading to wide spread of cellular hypoxia and vital organs dysfunction.

4. 37 yr male involved in RTA,(driver), brought to ER by Paramedics
BP 90/50 mmHg, HR 120/min, RR 28/min
Perfuse sweating, pallor, tenderness over chest & upper abdomen
What is wrong with him? D Dx?
What LAB investigation is required for the Dx?
What is your plan for treatment?

5. 52 yr Diabetic female patient admitted with foot ulcer for debridement
52 yr Diabetic female patient admitted with foot ulcer for debridement. 2 days later pt developed fever, confusion and they called you to assess the patient.
What is your approach?
What is plan for treatment?

6. 22 yr male patient came to ER with renal colic, your colleague prescribed an antibiotic & pain killer for him.
On administration of his medicine,
he collapses.
What is your approach?

7. 75 year old female admitted to the hospital 4 days ago with chest pain, S.O.B., diagnosed as MI & was started.
Early this morning the patient developed hypotension, tachycardia, SOB
What is wrong with her?

8. Types of Shock
Hypovolemic
Distributive
Obstructive
Cardiogenic

10. Shock Features Septic Cardiogenic Hypovolemic Blood Pressure ↓
Shock Features
Septic
Cardiogenic
Hypovolemic
Blood Pressure ↓
Heart rate ↑
Respiratory rate
Mentation
Urine output
Arterial pH
Is cardiac out[put reduced? No
Yes
Pulse pressure
Diastolic pressure
↓↓↓
Extremities/ Digits
Warm
Cool
Nailbed return
Rapid
Slow
Heart sounds
Crisp
Muffled
Temperature
↑ or ↓ ↔
White cell count
Site of infection
+ + -
Is the heart too full?
Symptoms/clinical context
Sepsis/liver failure
Angina / ECG
Hemorrhage/dehydration
Jugular venous pressure
S3, S4, gallop rhythm
+ + +
Respiratory crepitation
Chest X-ray
Normal
Large heart, ↑upper lobe flow, pulmonary edema

11. Pathophysiology of Shock
Oxygen Delivery:
PaO2 Hb CO
CO = SV X HR

12. Compensatory & Decompensatory Mechanisms
Autonomic Nervous System
Hormonal mechanism
Peripheral Vascular system
Myocardial Depression
Transcapillary refill
Down regulation of Catecholamines receptors

13. The mainstay of shock therapy
Improving Oxygen Delivery: (by raising hemoglobin concentration, cardiac output, or arterial saturation).
Reduce Oxygen Consumption.
Identify and treat the precipitants of hypoperfusion.

14. Therapeutic Options Early Diagnosis Need for ICU
Identification of Cause
Prevention:
*Aseptic Technique * Monitoring
*Perioperative Antibiotics *Vaccination

15. Fluid Resuscitation Colloids vs Crystalloids Fluid replacement
Augmentation of SV
Fluid
Inotropes
Vasodilators

16. Future Directions
Better Outcome: Advanced monitoring and ICU facilities.
More patients: elderly, major surgeries, more infection & more invasive devices.
Outlook is bright as we are unrevealing the secrets of shock.