Shock is defined as inadequate organ perfusion & tissue oxygenation.

shock results in hypo perfusion Delivery of o2 & substrate decreases. Cellular dysfunction & cellular injury.

Formulas.
BP = CO x PVR. CO = SV X HR.

Classification of shock.
Hypovolemic. Distributive. Cardiogenic. Obstructive. Shock due to endocrine disorder. 1.adrenal gland insufficincy. 2. hypothyroidism.

Hypovolemic shock ( inadequate ventricular filling).

Hemorrhage. Third space losses e.g. increased capillary leak in burns. GI losses e.g. diarrhea, fistulas, vomiting. Transdermal losses e.g. excessive sweating. Polyurea e.g. DI, diuretics. Inadequate fluid intake.

Obstructive shock ( flow obstruction).

Tension pneumothorax. pericardial tamponad. Pulmonary embolus. Lung hyper inflation.

Cellular & organ response.

Cellular response. Interstitial transport of nutrients is impaired (o2 , glucose , AA , FA ) Intracellular high energy phosphate stores declines i.e. .ATP. There is an accumulation of H+ , lactate & other products of anaerobic metabolism.

Clinical manifastation .
Tachycardia. Dyspnea. Low BP. The skin is cold. Cyanosis of the skin & mucus membrane.

Identifying dyspnea.
Tachypnea. Inability to speak more than a few words b/n breaths. Agitation/ refusal to lie down. Use of accessory muscle. Retraction of supraclavicular/ suprasternal/ intercostal tissues. Nasal flaring/ pursing of lips.

Management.
Oxygen ( supplemental oxygen ) Fluid therapy. Drugs inotrops ( dopamine , dobutamine,NE , epinephrine, phenylephrin, ephedrine.)

Receptor selectivity of adrenergic agonists

drug Alpha-1 Alpha-2 + ++ ++ ++ 0 ? Beta-1 + +++ ++ ++ +++ ++ Beta-2 0 ++ 0 + + + Dopamine rgic 0 0 0 +++ 0 0 Phenylephr +++ ine EP NE Dopamine Dobutamin e ephedrine ++ ++ ++ 0/+ ++