Shock
Gastrointestinal surgical department
of affiliated hospital of jining medical college
Objectives:
• The concept of shock
• List different types of shock
• Explain the pathophysiology of
shock
• Describe the signs and
symptoms of shock
• Discuss appropriate treatment of
shock
What’s Shock?
Concept
• Defined as a state of inadequate
perfusion, occurs when there is
inadequate circulation
• Tissues are deprived of oxygen
• Results in cellular metabolism
disturbence 、 waste
accumulation 、 dysfunction
Circulation
Types of Shock
• Hypovolemic Shock
• Cardiogenic shock
• Vasogenic Shock
Anaphylactic Shock
Septic Shock
Neurogenic Shock
Trauma
Hypovolemic Shock
Hypovolemic shock is loss of blood the
point where the metabolic needs of the
body cannot be met.
An individual who loses approx. 1/5 or
1000 ml of their normal blood volume
will probably go into shock.
Hypovolemia can also be caused by
burns.
Can also be caused by movement of
fluid into another body space
Cardiogenic Shock
Failure of the cardiac muscle to
act as a pump
The heart can no longer perform
adequately and is unable to pump
sufficient blood to the organs
Neurogenic
Vasogenic Shock
Caused by an increase in the size
of the vascular bed due to massive
vasodilation or Peripheral pooling
of blood.
Still have a normal blood volume,
but even the normal amt. of blood
cannot adequately fill the
increased size of the capillary bed.
Neurogenic, septic, or
Neurogenic
Neurogenic Shock is caused by
dilation of blood vessels secondary
to nervous factors such as:
Brain damage.
Deep spinal anesthesia.
It results in vasomotor collapse &
venous pooling.
Septic Shock andAnaphylactic
Shock
Septic Shock
Caused by bacterial infection,
immunosuppression
Anaphylactic Shock
A massive allergic reaction
Pathophysiology of shock
All causes of Hypoperfusion
shock.
hypoxia circulatory redistribution
Anaerobic acidosis
metabolism
Cellular elaboration of
injury inflammatory mediator
septic complication MODS
Microcirculation
Microcirculation change
At the onset of shock & during the
compensatory stage, the systemic &
microcirculatory system work together
& their activities tend to remain
coordinated
With the systemic system, there is
Increased HR,vasoconstriction
In the microcirculation, there is
Vasoconstriction
Microcirculation change
As Shock Progresses
The systemic circulation remains
vasoconstricted to get blood back to the
heart. At this point, the cells are
becoming anoxic because there has
been a decreased amt. of blood given to
them because the systemic circulation
has been constricted.
As a result, the microcirculation
( down near the cells) dilates in order to
get blood to the tissue.
Intestinal Changes
Because the intestines really
aren't vital to life, they are the 1st
organs in the body to lose their
supply of blood.
As a result the bowel becomes
anoxic.
Tissue necrosis results & bacteria
are released into the abdominal
cavity
Kidney’s change
The kidneys can compensate
fairly well for a time
When the B/P begins to fall
oliguria sets
Oliguria results in kidneys losing
their ability to regulate electrolytes
& acid base balance
Changes in the acid base balance
Respiratory change
Ventilation is going to be a priority
because most patients develop tissue
hypoxia
The cells become 02 starved
Body begins to hyperventilate & to
blow up excess C02
Results in respiratory alkalosis
Stages of Shock
1 st Stage = Initial Phase.
The CO is insufficient to meet the
metabolic needs of the body but
not low enough to produce
symptoms.
Patient is anxious & alert, altered
mental status, increased
respirations.
Stages of Shock
2 nd Stage = Compensatory Stage.
Due to catacholamines being
released you will see during the
compensatory stage:
An Increase in HR. Increase in CO.
Vasoconstriction.
B/P WNL (Due to compensation) or
decrease of 10-15 mm. Hg.
Stages of Shock
3 rd stage = Progressive stage.
Unfavorable signs & symptoms
become more apparent to you. You
will see:
Falling B/P.
Increased heart rate.
Oliguria.
System dysfunction begins.
Stages of Shock
4th stage = Irreversible Stage
During this stage, no matter
what is done the outcome is death
There is myocardial depression
There is massive capillary
dilation
Blood remains pooled in the
extremities
Hemorrhagic shock
The Blood
• Blood performs many individual functions
necessary to sustain life
• Functions of the blood include:
– Carry O2 and CO2 (respiration)
– Carry food to the tissues (nutrition)
– Remove wastes (excretion)
– Carries water, hormones and salt (body
regulation)
– Protects against disease—causing organisms
(fights
infection)
• Blood containing red and white blood cells &
Blood Vessels
• 3 types of blood vessels
– Arteries
• Carry blood away from the heart
(oxygenated)
– Veins
• Return blood to the heart
(deoxygenated)
– Capillaries
• Where oxygen, nutrients, and waste
exchange
Types of Bleeding
– Internal bleeding
• Cannot be observed directly
– External bleeding
• Can be observed through a break
in the skin
External Bleeding
• 3 types of external bleeding
– Arterial bleeding
• Bright red/spurting blood from an
artery
• Blood loss is rapid and profuse
– Venous bleeding
• Dark red/flowing blood from a vein
• Blood loss can be profuse
– Capillary bleeding
• Red/oozing blood from a bed of
capillaries
