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Shock

Shock. Dr. Afsar Saeed Shaikh M.B.B.S, M.Phil. Assistant Professor of Chemical Pathology Pathology Department, KEMU, Lahore. INTRODUCTION. Cardiovascular Collapse Final common pathway Definition:

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Shock

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  1. Shock Dr. Afsar Saeed Shaikh M.B.B.S, M.Phil. Assistant Professor of Chemical Pathology Pathology Department, KEMU, Lahore.

  2. INTRODUCTION • Cardiovascular Collapse • Final common pathway • Definition: ‘A clinical entity characterized by systemic hypoperfusion caused by reduction either in cardiac output OR in the effective circulatory blood volume’

  3. INTRODUCTION • Clinical Effects of Shock: • Hypotension • Impaired tissue perfusion • Cellular hypoxia

  4. Shock • ETIOLOGICAL CLASSIFICATION: • Cardiogenic Shock • Hypovolemic Shock • Septic Shock (Endotoxin Shock) • Neurogenic Shock • Anaphylactic Shock

  5. Stages of Shock • FIRST stage; Non-progressive Stage: • Reflex compensatory mechanisms are activated • Profusion of vital organ is maintained

  6. Stages of Shock • 2nd Stage; Progressive Stage: • Tissue hypoperfusion • Circulatory & metabolic imbalances leading to Acidosis

  7. Stages of Shock • 3rd Stage; Irreversible Stage: • Cellular & tissue injury • Even with correction of hemodynamic defects, survival is not possible

  8. Mechanism of different Stages of Shock • 1. Non-progressive Stage : • Neurohumoral Mechanisms maintain cardiac output and blood pressure: • Baroreceptors reflexes • Release of catecholamine • Activation of renin-angoitensin axis • ADH release • Generalized sympathetic stimulation

  9. Mechanism of different Stages of shock • 1. Non-progressive Stage : • Different Clinical Outcome of these compensatory mechanisms: • Tachycardia • Peripheral vasoconstriction (cool & pale skin) • Renal conservation of fluid

  10. Mechanism of different Stages of shock • 2. Progressive Stage : • Widespread hypoxia: • Anaerobic glycolysis • Production of lactic acidosis • pH lead to blunting of vasomotor response leading to vasodilatation • Peripheral pooling of blood • cardiac output

  11. Mechanism of different Stages of shock • 2. Progressive Stage : • Different Clinical Outcome of these failing mechanisms: • Feeble, failing pulse • Mental confusion • urine output

  12. Mechanism of different Stages of shock • 3. Irreversible Stage : • Widespread Cellular injury: • Damage to the organelle of cells • Leakage of lysosomal enzymes • Production of nitric oxide by cells • Worsened myocardial contractility

  13. Mechanism of different Stages of shock • 3. Irreversible Stage : • Different Clinical Outcome of cellular injury: • Septic shock (entry of intestinal flora into circulation) • Complete renal shutdown (acute tubular necrosis) • Downward clinical spiral

  14. THANK YOU!

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