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Pathophysiology of Shock
Pathophysiology of Shock
Pathophysiology of Shock
OF SHOCK
SPEAKER: DR. DEEPEN CHETTRI
MODERATOR: DR. TH BIJOY SINGH
PROF. DEPTT. OF FORENSIC
MEDICINE
DEFINITION OF SHOCK
reduced CO
1. Hypovolaemic shock
2. Cardiogenic shock
3. Distributive shock
4. Obstructive shock
HYPOVOLAEMIC SHOCK
• Reduced CO is due to low blood volume
• Also known as cold shock
Causes
1. Hemorrhagic shock
2. Surgical shock
3. Burns shock
4. Dehydration shock
5. Traumatic shock
CARDIOGENIC SHOCK
• Heart’s pumping ability is reduced
• Severe systolic dysfunction
• Venous return is not pumped out
• So reduced CO
• Congestion of lungs and vicera
• Also know as congested shock
CAUSES
1. Myocardial infarction
2. Cardiac arrhythmias
3. Congestive heart failure
DISTRIBUTIVE SHOCK
volume
• Also known as warm shock
DISTRIBUTIVE SHOCK
Four types:-
I. Neurogenic shock
II. Anaphylactic shock
III. Septicaemic shock
IV. Endotoxic shock
NEUROGENIC SHOCK
Causes :-Two types
1. Marked reduction in sympathetic
vasomotor tone
b) Spinal anaesthesia
c) Brain damage
• Septicaemia ?
• Bowel perforation , peritonitis
• Toxins produced by bacteria
• Generalised increase vascular permeability
ENDOTOXIC SHOCK
• Closely related to septic shock
• Seen in patients having gram negative
infection.
OBSTRUCTIVE SHOCK
• External pressure on the heart which
reduces CO
• Reduces ventricular filling
› Pericardial tamponade
› Tension pneumothorax
› Constrictive pericarditis
STAGES AND CLINICAL FEATURES OF
SHOCK
› Mechanoreceptor response
› CNS ischemic response
› Others responses
MECHANORECEPTORS
chemoreceptor
RECEPTORS
INNERVATION
• Carotid sinus
Glossopharyngeal nerve
• carotid body
• Aortic arch
Vagus nerve
• Aortic sinus
BARORECEPTOR REFLEX
• Due to hypoxia
• When the blood pressure fall below
70mm/hg
CNS ISCHEMIC RESPONSE
Ischemia of VMC
Activation of VMC
Increases sympathetic discharge
Increases BP , HR , CO
OTHER RESPONSES
• TACHYCARDIA
• VASOCONSTRICTION
Occurs in all vessels except cerebral and
Coronary vessels
So it increases venous return
In turn increases CO
Skin becomes pale and cold
Vasoconstriction of kidney reduces GFR(glomerular
filtration rate)
Vasoconstriction of skeletal muscle
So bypassing of blood to vital organs
Action
Increases CO
INCREASED SKELETAL MUSCLE
ACTIVITY
• Increased glucocorticoids
• Increases sensitivity of vessels to catecholamines
INTERMEDIATE COMPENSOTARY
MECHANISM
• RAAS
• Reverse stress relaxation
• Capillary fluid shift mechanism
LONG TERM COMPENSATORY
MECHANISM
proteins
› Plasma volume by 12 – 72 hours
› Proteins by 3-4 days by liver
• Restoration of red cell mass – will occur within 10
days and fully restored by 4-8wks
PROGRESSIVE SHOCK
• Occurs after 15-25% loss of blood volume
• Compensatory mechanisms are not
effective
• Despite Intense vasoconstriction
vasodilatation
• So CO and BP are further decreased
PERIPHERAL CIRCULATORY
FAILURE
• Hypoxia in GIT
circulation
• Damage liver and reaches systemic
circulation
• Systemic toxemia and septicaemia