3. TYPES OF SHOCK
Dr Farzana Salman

4. SHOCK
Generalized inadequate blood flow throughout the body causing tissue damage

5. CIRCULATORY SHOCK
Depression of body functions due to reduced blood flow to the tissues because of some disorder of the cardiovascular system

6. STAGES OF CIRCULATORY SHOCK
Non progressive stage
Progressive stage
Irreversible stage

7. Causes/Classification of Circulatory Shock

8. Causes of shock Reduced blood volume (Hypovolumic shock)
Hemorrhage
Trauma
Surgery
Burns
Dehydration
Increased vascular capacity
Neurogenic shock
Anaphylactic shock
Septic shock
↓ Venous return

9. Causes of shock Obstruction to blood flow ↓ Venous return
Cardiac tamponade
Tumors in myocardium
Thromboembolism
Cardiac diseases ↓ Pumping ability
Myocardial ischemia
Congestive heart failure
Arrhythmia
Severe heart valvular dysfunctions

10. Manifestations ↓BP Tachycardia Vasoconstriction
↓ systolic pressure due reduced filling and reduced stroke volume
↓ diastolic Pressure
↓ pulse pressure
Stagnant hypoxia
Pale ,cold , clammy skin

11. Manifestations Sweating Cyanosis ↓Urinary out put Acidosis
↓ Blood flow to the vital organs affected
↓ Blood flow to brain → fainting
Death due to brain ischemia or cardiac arrest

12. Compensatory mechanisms
BP maintained
Baroreceptor flex
Chemoreceptor flex
CNS ischemic response
Sympathetic stimulation
All of the above leads to
Vasoconstriction → ↑PR →↑BP
Venoconstriction →↑VR →↑COP →↑BP
Force and rate of heart contraction
More effective in BP maintenance
Less effective in COP maintenance

13. Compensatory mechanisms
Reverse stress relaxation phenomenon
Rennin angiotensin system
Vasopressin
Epinephrine and norepinephrine by adrenal medulla.
Mechanisms that return the blood volume back to normal

14. Progressive Shock Cardiac depression. Vasomotor failure
Blockage of very small vessels by sludged blood
Increased capillary permeability
Release of toxins by ischemic tissues
Cardiac depression caused by endotoxin
Generalized cellular deterioration.

15. Progressive Shock
Tissue necrosis
Acidosis in shock

16. P R O G R E S S I V E Shock

17. Arterial pressure at different degrees of hemorrhage
Nonprogressive shock
Progressive shock

18. Progressive shock
Increasing cardiac depression

19. Irreversible shock

20. Increased vascular capacity
Neurogenic shock
General anesthesia
Spinal anesthesia
Ischemia of brain causing vasodilatation
Vasovagal syncope
Postural syncope
Carotid sinus syncope
Vasodilatation

21. Increased vascular capacity
Anaphylaxis
Exaggerated allergic reaction
Antigen-antibody reaction→ release of histamine, some other vasodilators
Vasodilatation
↑permeability
Exudation of fluid → further reduction in blood volume
Blood volume to total vascular capacity reduced

22. Increased vascular capacity
Septic shock
Severe infection anywhere in the body
Bacteria produce toxins
Generalized Vasodilatation
Weakening of myocardium
↑ capillary permeability
Exudation of fluid → further reduction in blood volume
Blood volume to total vascular capacity reduced

23. Cardiogenic shock
Many IHD patients die of sudden ventricular fibrillation
More chances in large infarction
Can develop even in small infarctions
Sometimes even after many days of infarction (but less likely)

24. Cardiogenic shock Infarction
After a few days degeneration of infarcted muscle
Thinning of the site
Systolic stretch with each contraction
Worsening of the systolic stretch with the passage of time
Rupture of the heart
Collection of blood in the pericardial cavity
Cardiac tamponade
Quick death

25. High COP shock Excessive metabolism Abnormal tissue perfusion pattern
Thyrotoxicosis
Abnormal tissue perfusion pattern
Shunts
Inability of tissue to utilize O2 & nutrients
Electron transport chain poisoning

26. Treatment of shock Postural change Blood transfusion
Plasma transfusion
Transfusion of plasma substitutes
Plasma expanders- dextran
Concentrated human albumin serum
Hypertonic solutions
Sympathomimetc drugs
Glucocorticoids
Oxygen therapy