-Dr.

Lalith Kumar Surgical registrar

Shock

Shock is characterized by systemic hypotension due to either

reduced cardiac out put or reduced effective circulating blood volume The consequences are impaired tissue perfusion and cellular hypoxia

Classification :
Hypovolaemic Cardiogenic Obstructive Distributive Endocrine

Haemorrhagic
Plasma loss Fluid loss

Septic shock
Anaphylactic shock Neurogenic shock

Stages-Signs
At the onset, the cellular injury is reversible, however prolonged

shock eventually lead to irreversible injury that often fatal. Compensated-no clinical signs of shock, Blood is directed to vital organs Occult hypoperfusion-metabolic acidosis inspite of normal output & vitals Decompensated-Signs of shock present mild-mild tachycardia,tachypnea,anxiety,output reduces,cool clammy skin,prolonged capillary refilling time,Pulse pressure decreases moderate-tachycardia,tachypnea,drowsy/confused, urine output dips below 0.5ml/kg/hr, B.P. starts to fall severe-profund tachycardia,hypotension,unconcious, no urine output

Haemorrhagic shock

Haemorrhage-Primary/reactionary/secondary

Consealed/revealed;acute/chronic Surgical/non surgical

Blood loss 1st degree-<15% 2nd degree-15-30% 3rd degree-30-40% 4th degree->40% Severarity also depends on mode of haemorrhage; -upto 20%loss has no effect wheather it is acute/chronic -If 33%of blood is lost acutely it may be fatal & -If 50% of blood is lost on chronic,it may be nonfatal

Pathophysiology of haemorragic shock

Haemorrhage ed effective circulatory volume ed venous return ed cardic output ed o2 supply Anoxia Shock

Septic shock
Shock sets in when cardinal signs of inflammation occuring in

tissues remote from the infection -due to dysregulation & massive release of various proinflammatory mediators-cytokines:ILs, TNFs, PGs, Kinins etc. Infection-invasion of sterile tissue by organism Bacteremia-bacteria in blood Sepsis-Temp.>38.5oc/<35oc;H.R.>90;RR>20;WBC>12000/<4000 Severe sepsis+sign of hypoperfusion/organ dysfunction Septic shock+mean BP<60 despite adequate fluids/>60 with dopamine>5mcg/kg/mn SIRS=SEPSIS

Pathophysiology of septic shock

 Not all cases of infection have same course leads to

septic shock -depends on-Host immunity -site of infection -virulence of organism

Management of shock
In all types of shock early correction of physiological

abnormalities-hypoxemia/hypotension &measures to detect cause of shock O2 by mask/Intubation Perfusion-crystalloids/colloids/blood -assessment of perfusion:CVP/ScvO2;Dynamic haemodynamic measures;Cardiac output in response to passive leg raising Control of bleeding Control of septic foci