Shock: Pathophysiology, Diagnosis, and Management, Study Guides, Projects, Research of Medical Sciences

Download Shock: Pathophysiology, Diagnosis, and Management and more Study Guides, Projects, Research Medical Sciences in PDF only on Docsity!

shoc

k

Dr. JACK THOMAS.

Perpetual Succour

Hospital

Department of Surgery

GENERAL OBJECTIVE

To understand the pathophysiology

and diagnosis of shock as well as the

priorities for their management

OUTLINE

I. Definition of Terms

II. Pathophysiology of shock

III. Ischemia–reperfusion injury

IV. Classification of Shock

V. Natural History of Shock

VI. Management Principles

VII.Monitoring Endpoints

VIII.Management Issues

Shock:

“A momentary pause in the act of

death.”

-John Collins Warren, 1800s

Pathophysiology

ATP + H

2

O ADP + P

i

• H

+

• Energy

Acidosis results from the accumulation of acid

when during anaerobic metabolism the creation of

ATP from ADP is slowed.

H

shift extracellularly and metabolic acidosis

develops

BLALOCK CLASSIFICATION

 Hypovolemic Shock

loss of circulating blood volume

 Vasogenic Shock

↓ resistance w/in capacitance vessels

• (^) Neurogenic Shock

acute loss of sympathetic vascular tone

• Cardiogenic Shock

failure of the heart as a pump

CLINICAL CLASSIFICATION



Hypovolemic Shock



Distributive (Vasodilatory) Shock

 Septic



Neurogenic

 Anaphylactic



Adrenergic



Cardiogenic Shock



Intrinsic

 Compressive



Obstructive Shock



Traumatic Shock

vicious cycle of shock

THE TRIAD OF DEATH

HYPOVOLEMIC SHOCK

With total body

fluid depletion

Hemorrhage

Gastrointestinal tract

losses

Renal losses

Skin losses

Open wound losses

Burns

Without total body

fluid depletion

Redistribution of the

intravascular fluid to the

interstitial or intracellular

space

Decreased preload due

to increased

intravascular capacity

(Distributive shock)

Acute blood loss

⇓

Decreased baroreceptor stimulation

⇓

Decreased inhibition of vasoconstrictor centers

Diminished output (Atrial Stretch Receptors)

⇓

Increase vasoconstriction & Peripheral arterial resistance

Hypovolemia ⇨ Sympathetic stimulation

HYPOVOLEMIC SHOCK

HYPOVOLEMIC SHOCK



Treatment:

1. Secure the airway
2. Control the source of blood loss
3. Intravenous volume resuscitation

CARDIOGENIC SHOCK

Acute MI

 Pump failure

 Mechanical complications

• (^) Acute mitral regurgitation

from papillary muscle

rupture

• (^) Ventricular septal defect
• (^) Free-wall rupture
• Pericardial tamponade
• (^) Right ventricular

infarction

Other causes

 End-stage cardiomyopathy

 Myocarditis

 Severe myocardial contusion

 Prolonged cardiopulmonary

bypass

 Septic shock with severe

myocardial depression

 Left ventricular outflow

obstruction

 Obstruction to left

ventricular filling

 Acute mitral regurgitation

 Acute aortic insufficiency