JAYOTI VIDYAPEETH WOMEN’S UNIVERSITY

FACULTY OF HOMOEOPATHIC SCIENCE

DEPARTMENT OF PATHOLOGY

SHOCK

CONTENTS• DEFINITION• TYPES OF SHOCK• CLASSIFICATION OF SHOCK• PATHOGENESIS OF SHOCK• PATHOPHYSIOLOGY OF SHOCK• CLINICAL FEATURES• EFFECT OF SHOCK ON VARIOUS ORGANS• THERAPEUTICS

DEFINITION

Shock is a condition in which the cardiovascular system fails to perfuse tissues adequately

It is a life- threatening clinical syndrome of cardiovascular collapse characterized by :-An acute reduction of effective circulating blood volume (HYPOTENSION)Inadequate tissue perfusion of cells and tissues (HYPOPERFUSION)

TYPES OF SHOCKTRUE (SECONDARY) SHOCK

• IMBALANCE BETWEENOXYGEN SUPPLY ANDOXYGEN REQUIREMENTS

INITIAL (PRIMARY) SHOCK

• SUDDEN REDUCTION IN THE VENOUS RETURN TO THE HEART

CLASSIFICATION & ETIOLOGY

HYPOVOLAEMIC SHOCKCARDIOGENIC SHOCKSEPTIC SHOCKTRAUMATIC SHOCKNEUROGENIC SHOCKHYPOADRENAL SHOCK

HYPOVOLAEMIC SHOCK INADEQUATE CIRCULATORY BLOOD VOLUME

CARDIOGENIC SHOCKSUDDEN REDUCTION IN CARDIAC OUTPUT

SEPTIC SHOCKDUE TO BACTERIAL INFECTION OR SEPTICEMIA

TRAUMATIC SHOCKSHOCK RESULTING FROM TRAUMA

NEUROGENIC SHOCKINTERUPPTION OF SYMPATHETIC VASOMOTOR SUPPLY

HYPOADRENAL SHOCKOCCURS FROM ADRENAL INSUFFICIENCY

PATHOGENESIS OF SHOCK

REDUCED EFFECTIVE CIRCULATORY BLOOD VOLUME

REDUCED SUPPLY OF OXYGEN TO THE CELLS AND TISSUES WITH RESULTANT ANOXIA

INFLAMMATORY MEDIATORS AND TOXINS RELEASED FROM SHOCK-INDUCED CELLULAR INJURY

PATHOGENESIS OF HYPOVOLAEMIC SHOCK

CAUSESLOSS OF RED CELL MASS DUE TO HAEMORRHAGE

MAJOR EFFECTS ARE :-

DECREASED CARDIAC OUTPUTLOW INTRACARDIAC PRESSURE

CLINICAL FEATURESINCREASED HEART RATE (TACHYCARDIA)LOW BLOOD PRESSURE (HYPOTENSION)LOW URINARY OUTPUT (OLIGURIA TO ANURIA)ALTERATION IN MENTAL STATE (AGITATED TO CONFUSED TO LETHARGIC)

PATHOGENESIS OF CARDIOGENIC SHOCK

CAUSESSEVERE LEFT VENTRICULAR DYSFUCNTION FROM VARIOUS CAUSESSUCH AS MYOCARDIAL INFARCTION

MAJOR EFFECTS ARE :-DECREASED TISSUE PERFUSIONMOVEMENT OF FLUID FROM PULMONARY VASCULAR BED INTO PULMONARY INTERSTITIALSPACE INITIALLY & LATER INTO ALVEOLAR SPACES

CLINICAL FEATURES

SUDDEN, RAPID HEARTBEAT (TACHYCARDIA)LOSS OF CONSCIOUSNESS WEAK PULSESWEATINGURINATING LESS THAN NORMAL OR NOT AT ALL RAPID BREATHING SEVERE SHORTNESS OF BREATH

PATHOGENESIS OF SEPTIC SHOCK

CAUSESRESULTS MOST OFTEN GRAM-NEGATIVE BACTERIA & LESS OFTEN FROM GRAM-POSITIVE BACTERIA

EFFECTS IMMUNE SYSTEM ACTIVATIONSEVERE SYSTEMIC INFLAMMATORY RESPONSE

CLINICAL FEATURESCOOL,PALE ARMS & LEGSHIGH OR VERY LOW TEMPERATURE, CHILLSLIGHT HEADEDNESSLITTLE OR NO URINELOW B.P. , ESP. WHEN STANDINGPALPITATIONSRAPID HEART RATE RESTLESSNESS, AGITATIONS, LETHARGY CONFUSION