SHOCK

107, 108
SHOCK

● Shock is the clinical condition of organ dysfunction resulting from an

imbalance between cellular oxygen supply and demand.
● There are multitude of heterogeneous disease processes that can lead
to shock.
● The organ dysfunction seen in early shock is reversible with
restoration of adequate oxygen supply.
● Left untreated, shock transmitted from this reversible phase to an
irreversible phase and death from multisystem organ dysfunction
(MSOF).
Pathophysiologic Classification of Shock
1. Distributive: Septic shock, Pancreatitis, Severe Burns, Anaphylactic
Shock, Neurogenic Shock, Endocrine Shock, Adrenal Crisis.
2. Cardiogenic: Myocardial Infarction, Myocardiris, Arrythmia,
Valvular(Severe aortic valve insufficiency & Severe Mitral Valve
Insufficiency)
3. Obstructive: Tension Pneumothorax, Cardiac Tamponade, Restrictive
Pericarditis, Pulmonary Embolism, Aortic Dissection.
4. Hypovolemic: Hemorrhagic, GI losses, Burns, Polyuria(Diabetic
Ketoacidosis, Diabetic Insipidus)
Stages of Shock
1. Stage of hypoperfusion and hypoxia: Aerobic
metabolism changes to anaerobic leading to lactic
acidosis (metabolic acidosis)
2. Stage of componsatory Shock: It is neuro endocrine
response to maintain the perfusion of vital organs like
brain, lungs and heart.
3. Stage of decomponsatory(progressive) shock: Here
componsatory mechanism fails, cell perfusion decreases
caused raised intracellular sodium but low intracellular
potassium. Microcirculation fails leading to failure of kidneys,
liver and lungs.
4. Stage of irreversible (refractory) shock: Here cellular
ATP metabolism is lost completely leading to
MODS(Multiorgan dysfunction syndrome) and MOF
(Multiorgan failure)
Types of Shock
● Neurogenic Shock
○ Caused by loss of sympathetic control of resistance vessels
resulting in massive dilatation of arterioles and venules.
○ It is a type of distributive shock resulting from loss of
sympathetic tone.
○ Causes massive vasodilatation in the venous vasculature →
venous return to heart → Cardiac output decreases.
○ Most common cause is injury to spinal cord above T6
● Sepsis:
○ Sepsis Syndrome: SIRS with confirmed infections process
associated with organ failure or hypotension.
○ Two phases:
■ Warm shock early phase: Hyperdynamic response,
vasodilatation.
■ Cold shock late phase: Hyperdynamic response.
○ Decompomsated state
● Anaphylactic Shock:
○ A type of distributive shock that results from widespread
systemic allergic reaction to an antigen.
○ Life threatening.
○ Caused by antibiotics such as beta-lactams, vancomycin,
sulfonamides and IgA deficiency.
● Cardiogenic Shock:
○ Impaired ability of the heart to pump blood due to failure of
left and right ventricle.
○ Most common cause is left ventricular myocardial infarction
(anterior)
○ Occurs when <40% ventricular mass damage.
○ Mortality rate: 80% or more.
Thank you