m


Ú State of acute circulatory insufficiency due to reduction in

effective circulatory volume leading to decreased tissue
perfusion resulting in cellular hypoxia and metabolic
derangement.
Ú Shock is an imbalance between oxygen delivery and demand
which results in cellular dysfunction and death ,which is
reflected in organ failure.
6



d



Ý {aemorrhage- trauma, GI bleeding,intra-abdominal bleeding

Ý Plasma loss - Burns

Ý Fluid loss ² {igh output GI fistula, Vomitting and Diarrhoea

2. 6 
  myocardial infarct, arrhythmia

This type of shock is caused by the failure of the heart to

pump effectively. This can be due to damage to the heart muscle,
most often from a large myocardial infarction.
x
     vaso-vagal, spinal cord injury
Neurogenic shock is the rarest form of shock. It is caused
by trauma to the spinal cord resulting in the sudden loss
of autonomic and motor reflexes below the injury level. Without
stimulation by sympathetic nervous system the vessel walls relax
uncontrollably, resulting in a sudden decrease in peripheral vascular
resistance leading to vasodilation and hypotension.
4. 


 Ag-Ab reaction
Caused by a severe anaphylatic reaction to an allergen, antigen and
drug or foreign protein causing the release of histamine which causes
widespread vasodilation, leading to hypotension and increased capillary
permeability.
. < 
 
 infection
Ú 6 


 

 
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- 10% G(+) bacteria exotoxin
- other -viral
-fungal
-parasite
Ú Source of infection -mostly ² GIT ² perforation, obstruction
-biliary tract ² obstruction, perforation
-urinary tract ² obstruction
-Gynaecological
-Respiratory
-Any where in septic focus ² abscess,
cellulites etc.

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 adrenal gland insufficiency

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' 




 cardiac tamponade, tension

pneumothorax and pulmonary embolism

In this situation the flow of blood is obstructed which impedes

circulation and can result in circulatory arrest.
6
  
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6 

 
Ú 
 <
Ú due to hypoxia & increased sympathetic activity
Ú skin ² vascular constriction ² pale, cold, sweating
Ú Brain ² hypoxia ² change in conscious level ² confusion, restless
Ú CVS ² increased {R,
Ú BP ² narrow BP in early case
Ú decrease in both systolic and diastolic BP later
Ú Respiration ² increase rate (acidotic breathing)
Ú Renal ² decrease urine output ² increase concentration & specific
gravity
Ú GIT ² stress ulceration, ileus
impaired liver function
< 

<
Ý Pyrexia (fever), due to increased level of cytokines
Ý Systemic vasodialtion resulting in hypotension (low blood
pressure)
Ý Warm and sweaty skin due to vasodilation
Ý Systemic leukocyte adhesion to endothelial tissue
Ý Reduced contractility of the heart
Ý Activation of the coagulation pathways, resulting in disseminated
intravascular coagulation
Ý Increased levels of neutrophils
6 

Ý Similar to hypovolemic shock but in
addition:Distended jugular veins due to increased jugular
venous pressure
Ý Weak or absent pulse
Ý Arrhythmia, often tachycardic

' 

Ý Similar to hypovolemic shock but in
addition:Distended jugular veins due to increased jugular
venous pressure
Ý Pulsus paradoxus in case of tamponade
  

ÚAs with hypovolemic shock but in high spinal injuries may also be
accompanied by profound bradycardia due to loss of the cardiac
accelerating nerve fibres from the sympathetic nervous system at T1-T4.
ÚThe skin is warm and dry or a clear sweat line exists, above which the
skin is diaphoretic.
ÚPriapism due to Peripheral nervous system stimulation



ÚSkin eruptions and large bumps
Ú ocalised oedema, especially around the face
ÚWeak and rapid pulse
ÚBreathlessness and cough due to narrowing of airways and swelling of
the throat.
‰

 






Ý I At the time of accident

Ý II During transport to hospital
Ý III {ospital management
Ý
Ý I At the time of accident
Ý resuscitation of patient
Ý stop the obvious external bleeding ² pressure, position etc.
 II Transport to hospital
Ú continue resuscitative measure

III {ospital management

· Resuscitation ² until patient recover from shock
Î airway ² patent & clear
Î breathing ² adequate O2
Î maintain adequate circulation
Ú -control the external obvious bleeding
Ú -IV line open with wide bore needle
Ú -blood for G&M, indent blood
Ú -transfusion of crystalloid/colloid before getting food
Ú -transfusion of blood if available
Î monitoring of patient
Ú general condition
Ú vital sign ² PR, BP, RR, U.O,
Ú investigations - U&E, ABG, CVP
Ú Detection of the cause of bleeding & amount of
haemorrhage by {/O& P/E
Ú source of bleeding
Ú cause of bleeding
Ú amount of bleeding
Ý I/V ²source & cause by e.g- scopy, angiogram, radioactive
RBC
Ý Arrest of haemorrhage by
Ý physical means ² pressure, position etc.
Ý chemical means ² vasoconstriction agent, sclerotherapy etc.
Ý surgical means ² repair, excision, suturing etc.
Ý Prevention of further attack
Ý specific Rx of underlying cause
Ý Prevention & Rx of complication
Ý -Renal support ² good renal perfusion
Ý use dopamine
Ý Respiratory support ² O2 Rx, IPPV
Ý Cardiac support ² positive inotropic agent e.g.dopamine,
adrenaline
‰

 
 


Ý À

(  
)
 
Ý airway
Ý breathing
Ý maintain adequate circulatory volume
Ý IV broad spectrum antibiotics
Ý monitoring of patient - general condition, vital signs, U &
E, ABG etc.
II Detection of the source of infection & Rx
Ý {istory
Ý physical examination
Ý Investigations
Ý Rx the source of infection ² drainage of septic focus, wound
swab for C&S
III Supportive Rx & antibiotic Rx
Ý Specific A/B according to C&S result
Ý Analgesic/ antipyretic
Ý Nutritional support
Ý Rx of factors which impaired wound healing & immunity
IV Prevention & Rx of complication
Ý Renal support
Ý Respiratory support
Ý Cardiac support
Ý V Prevention of further attack ² Rx the underlying cause
Ý 6  
is a medical emergency. Treatment requires
hospitalization. The goal of treatment is to save your life and treat
the cause of shock.
Ý Medications may be needed to increase blood pressure and heart
function, including:
Ý Dopamine
Ý Dobutamine
Ý Epinephrine
Ý Norepinephrine
Ý When an arrhythmia is serious, urgent treatment may be needed
to restore a normal heart rhythm. This may include:
Ý Electrical "shock" therapy (defibrillation or cardioversion)
Ý Implanting a temporary pacemaker
Ý Medications given through a vein (intravenous)
Ý You may receive pain medicine if necessary. Bed rest is
recommended to reduce demands on the heart.
Ý Getting oxygen lowers the workload of the heart by reducing
tissue demands for blood flow.
Treatment of   

Ý arge volumes of fluid may be needed to restore normal
hemodynamics
Ý Dopamine (Intropin) is often used either alone or in
combination with other inotropic agents.
Ý Vasopressors (Ephedrine, Norepinephrine, Phenylephrine)
Ý Atropine (speeds up heart rate and Cardiac Output)
a 

)
#
is a medical emergency which may require resuscitation measures
such as airway management, supplemental oxygen, large volumes
of intravenous fluids, and close monitoring. Administration of
epinephrine is the treatment of choice with antihistamines and
steroids often used as adjuncts.