Circulatory shock

Dr. Niranjan Murthy H L

Asst Prof of Physiology
SSMC, Tumkur
• Differentiate circulatory shock from electric or
the spinal shock
• “ inadequate tissue perfusion with a relatively
or absolutely inadequate cardiac output”
• “ generalized inadequacy of the blood flow
throughout the body to the extent that body
tissues are damaged because of too little
delivery of oxygen or nutrients to the cells”
 Physiologic causes
1. Circulatory shock associated with reduced
cardiac output:
(a) pump failure- MI, myocarditis
(b) reduced venous return- hemorrhage
2. Circulatory shock with normal cardiac output:
(a) excessive metabolism- hyperthyroidism
(b) abnormal tissue perfusion patterns-
massive AV shunts
• Pulse pressure

• Perfusion

• Mean systemic filling pressure

• Arterial pressure- misleading

• “Shock breeds shock”

 Stages of shock

• Non-progressive stage or compensated stage

• Progressive stage

• Irreversible stage or Refractory stage

 Types of shock
1. Hypovolemic shock
(a) Hemorrhage
(b) Burns
© Surgery
2. Distributive or vasogenic shock
(a) Neurogenic
(b) Anaphylaxis
© Sepsis
3. Cardiogenic shock
(a) Myocardial Infarction
(b) Arrhythmias
4. Obstructive shock
(a) cardiac tumour
(b) Cardiac Tamponade
Hemorrhagic Shock
hemorrhage

Reduced filling pressure

Reduced venous return

Reduced cardiac output

Shock
 Bleeding volume Vs cardiac output and
arterial pressure
• 10% of total blood
volume can removed
without any effect on
CO & BP
• Sympathetic
discharge plays a
compensatory role
• Cerebral & coronary
flow is maintained
 Non-Progressive shock

• Baroreceptor reflex
• Chemoreceptor reflex
• Reverse stress relaxation
• Capillary fluid shift
• Angiotensin mechanism
• vasopressin
Course of arterial pressure in dogs after different degrees of acute hemorrhage
Progressive Shock- Vicious Cycle
Cardiac Depression
• Vasomotor failure
• Sludging of blood
• Increased capillary permeability
• Toxin release by ischemic tissue
• Generalized cellular deterioration
• Acidosis
 Irreversible Shock
• Depletion of cellular high-energy phosphate
reserves
 Neurogenic Shock
• Sudden loss of vasomotor tone
• Reduced mean systemic filling pressure
• Venous pooling of blood
• Causes:
1. Deep general anaesthesia
2. Spinal anaesthesia
 Anaphylactic Shock

• Allergic condition
• Massive release of histamine
• Vasodilatation
• Warm shock
• Distributive shock
 Septic Shock
• High fever
• High cardiac output
• Sludging of blood
• Disseminated intravascular coagulation
• Activated Protein C
 Physiological basis of treatment
• Blood and plasma transfusion
• Plasma substitutes
• Glucocorticoids
• Sympathomimetic drugs
• Head-down tilt
• Oxygen therapy