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    Lập Trương Minh Quốc
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    Shock is defined as acute or subacute generalized circulatory failure caused by a reduction in cardiac output. There are several types of shock including hypovolemic, cardiogenic, hormonal, metabolic, septic, and neurogenic shock. Hypovolemic shock is caused by fluid loss either externally through bleeding, vomiting, or diarrhea, or internally through organ damage or rupture. Septic shock is caused by bacteria, often gram-negative, and their toxins, initially increasing cardiac output but later decreasing it. The body responds to falling blood pressure through chemoreceptor and baroreceptor reflexes in the brain and adrenal medulla release of epinephrine to constrict blood vessels and increase heart rate and contract

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    Shock is defined as acute or subacute generalized circulatory failure caused by a reduction in cardiac output. There are several types of shock including hypovolemic, cardiogenic, hormonal, metabolic, septic, and neurogenic shock. Hypovolemic shock is caused by fluid loss either externally through bleeding, vomiting, or diarrhea, or internally through organ damage or rupture. Septic shock is caused by bacteria, often gram-negative, and their toxins, initially increasing cardiac output but later decreasing it. The body responds to falling blood pressure through chemoreceptor and baroreceptor reflexes in the brain and adrenal medulla release of epinephrine to constrict blood vessels and increase heart rate and contract

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    © All Rights Reserved
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    12 views30 pages

    Shock

    Uploaded by

    Lập Trương Minh Quốc
    Shock is defined as acute or subacute generalized circulatory failure caused by a reduction in cardiac output. There are several types of shock including hypovolemic, cardiogenic, hormonal, metabolic, septic, and neurogenic shock. Hypovolemic shock is caused by fluid loss either externally through bleeding, vomiting, or diarrhea, or internally through organ damage or rupture. Septic shock is caused by bacteria, often gram-negative, and their toxins, initially increasing cardiac output but later decreasing it. The body responds to falling blood pressure through chemoreceptor and baroreceptor reflexes in the brain and adrenal medulla release of epinephrine to constrict blood vessels and increase heart rate and contract

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    © All Rights Reserved
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    of 30

    PATHOPHYSIOLOGY

    SHOCK
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    DEFINITION:

    Shock is the term given to acute or subacute progressive


    generalized circulatory failure with an abnormal
    microcirculation and underperfusion of vital organs.

    In a wider sense shock also includes disorders of O2


    supply and utilization with (initially) undiminished perfusion.

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    CAUSE:

    Reduce cardiac output (↓CO).

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    CLASIFICATION:

    - Hypovolemic shock (hemorrhagic shock)


    - Cardiogenic shock
    - Hormonal shock
    - Metabolic shock (anaphylactic shock)
    - Septic – toxic shock
    - Neurogenic shock

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    HYPOVOLEMIC SHOCK:

    ↓ circulation volume

    ↓ CVP

    ↓ VR

    ↓ SV

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    HYPOVOLEMIC SHOCK:

    FLUID LOSS EXTERNALLY FLUID LOSS INTERNALLY

    - Hemorrhagic (bleeding) - Fractures (esp. thigh, pelvis)


    - Vomiting - Rupture of aortic aneurysm
    - Diarrhea - Rupture of spleen
    - Diabetes (mellitus, insipidus) - Ileus
    - Diuretics - Peritonitis
    - Polyuria (after ARF) - Liver cirrhosis
    - Burning - Acute pancreatitis

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    SEPTIC – TOXIC SHOCK:

    Cause: bacteria (Gram negative).

    (1) toxins (2) ↑ CO (3) tachycardia, ↓ peripheral resistance


    EARLY STAGE
    (4) ↓ BP (5) respiratory failure

    LATE STAGE (1) ↓ CO (2) ↑ peripheral resistance (3) DIC

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    METABOLIC – TOXIC SHOCK:

    Anaphylactic shock: drugs, food (allergy).

    Peripheral vascular distension (dilation).

    Venous pooling of blood

    ↓ CVP

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    Septic, anaphylactic, Myocardial infarct,
    Fluid loss Pulmonary edema
    hyperthermia AV block

    Hypovolemia Vasodilation

    Thirst
    Cardiac filling

    Cardiac output Cardiac contractility

    Hypotonia Blood pressure


    Hypoxia

    Rapid HR HR Sympathetic
    ORGAN DAMAGE
    Sweat Vasoconstriction
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    Cold, pallor
    BLOOD BLOOD
    PRESSURE VOLUME
    FALLS REDUCED

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    BLOOD
    PRESSURE
    FALLS

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    BLOOD
    PRESSURE
    FALLS

    chemoreceptor
    central
    PO2 (aortic arch,
    (medullary)
    carotid sinus)

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    BLOOD
    PRESSURE
    FALLS

    chemoreceptor
    central
    PO2 (aortic arch,
    (medullary)
    carotid sinus)

    anaerobic
    lactate, pH
    metabolism

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    BLOOD
    baroreceptor
    PRESSURE
    (aortic, carotid)
    FALLS

    chemoreceptor
    central
    PO2 (aortic arch,
    (medullary)
    carotid sinus)

    anaerobic
    lactate, pH
    metabolism

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    BLOOD
    baroreceptor
    PRESSURE
    (aortic, carotid)
    FALLS

    chemoreceptor
    central
    PO2 (aortic arch, sympathetic adrenal medulla
    (medullary)
    carotid sinus)

    anaerobic arterial
    lactate, pH epinephrine
    metabolism vasoconstriction

    peripheral
    resistance

    BLOOD
    PRESSURE
    RISES
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    BLOOD
    baroreceptor
    PRESSURE
    (aortic, carotid)
    FALLS

    chemoreceptor
    central
    PO2 (aortic arch, sympathetic adrenal medulla
    (medullary)
    carotid sinus)

    anaerobic arterial
    lactate, pH heart epinephrine
    metabolism vasoconstriction

    HR, peripheral
    contractility resistance

    BLOOD
    PRESSURE
    RISES
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    BLOOD
    baroreceptor venous
    PRESSURE VR
    (aortic, carotid) vasoconstriction
    FALLS

    chemoreceptor
    central
    PO2 (aortic arch, sympathetic adrenal medulla
    (medullary)
    carotid sinus)

    anaerobic arterial
    lactate, pH heart epinephrine
    metabolism vasoconstriction

    HR, peripheral
    contractility resistance

    BLOOD
    PRESSURE
    RISES
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    ADH,
    angiotensin II
    BLOOD
    baroreceptor venous
    PRESSURE VR
    (aortic, carotid) vasoconstriction
    FALLS

    chemoreceptor
    central
    PO2 (aortic arch, sympathetic adrenal medulla
    (medullary)
    carotid sinus)

    anaerobic arterial
    lactate, pH heart epinephrine
    metabolism vasoconstriction

    HR, peripheral
    contractility resistance

    BLOOD
    PRESSURE
    RISES
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    BLOOD
    VOLUME
    REDUCED
    BLOOD volume
    posterior
    VOLUME receptor hypothalamus
    pituitary
    REDUCED (atria)

    ADH

    water
    kidneys oliguria
    reabsorbtion

    BLOOD
    VOLUME
    INCREASES
    BLOOD volume
    posterior
    VOLUME receptor hypothalamus
    pituitary
    REDUCED (atria)

    ADH

    water
    kidneys oliguria
    reabsorbtion

    renal
    GFR
    perfusion

    BLOOD
    arterial capillary H2O flows into
    VOLUME
    vasoconstriction pressure capillaries
    INCREASES

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    BLOOD volume
    posterior
    VOLUME receptor hypothalamus
    pituitary
    REDUCED (atria)

    ADH

    water
    kidneys oliguria
    reabsorbtion

    renal
    GFR
    perfusion

    BLOOD
    arterial capillary H2O flows into
    capillaries VOLUME
    vasoconstriction pressure capillaries
    INCREASES

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    BLOOD volume
    posterior
    VOLUME receptor hypothalamus
    pituitary
    REDUCED (atria)

    ADH

    water
    kidneys oliguria
    reabsorbtion

    renin

    renal
    angiotensin II GFR
    perfusion

    BLOOD
    arterial capillary H2O flows into
    capillaries VOLUME
    vasoconstriction pressure capillaries
    INCREASES

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    BLOOD volume
    posterior
    VOLUME receptor hypothalamus
    pituitary
    REDUCED (atria)

    ADH

    water
    kidneys oliguria
    reabsorbtion

    adrenal
    aldosteron renin
    cortex

    cerebral renal
    thirst angiotensin II GFR
    cortex perfusion

    BLOOD
    arterial capillary H2O flows into
    capillaries VOLUME
    vasoconstriction pressure capillaries
    INCREASES

    water
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    Vasoconstriction

    blood flow
    viscosity velocity

    stasis

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    Volume Pressure

    bleeding Thrombus hypoxia

    Capillaries
    DIC
    damage

    volume precapillary
    outflow dilation

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    coronary
    pressure
    perfusion

    myocardial
    CO
    hypoxia

    acidosis,
    blood flow contractility
    ATP deficiency

    pulmonary
    thrombus
    edema

    pulmonary respiratory
    hypoxia
    embolism failure

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    Acute distress
    respiratory
    syndrome ADRS

    Acute renal failure

    INCIPIENT MANIFEST MULTIORGAN


    HYPOXIA Liver failure
    SHOCK SHOCK FAILURE

    Brain damage

    GIT ulcer

    DIC

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    Read more:
    THANKS

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