SHOCK

It is generalised inadequate blood flow throughout the body Usually results from inadequate cardiac output (Impaired Tissues Perfusion) Leading to Insufficient supply of O2 & nutrients, inadequate removal of metabolic waste products Resulting in tissue hypoxia & cellular death 3 types of circulatory shock: Hypovolemic shock Low- resistance shock Cardiogenic shock Hypovolemic Shock Due decreased blood volume . Causes of hypovolemia:i. Blood loss as in case of hemorrhage. ii. Plasma loss:a- severe burn b- dehydration eg vomiting & diarrhea The severity depends on the amount and rate of blood loss. It may be :Reversible :Irrevesible Low Resistance Shock Caused by widespread vasodilatation Leading to VR, CO & ABP Called warm shock because of high blood flow in the skin Has the same manifestations as Hypovolaemic shock except the warm skin Cardiogenic Shock Caused by severe depression of the pumping action of the heart The common cause is damage of myocardial muscle by AMI Other causes: cardiac trauma, cardiomyopathy, congestive heart failure Pulmonary embolism (termed obstructive shock) Manifestation of Shock 1. Decreased arterial blood pressure. 2. The pulse is rapid and weak - Stimulation of catecholamines secretion from suprarenal medulla (sympathetic activation). 3. Shallow rapid breathing - Acidosis stimulates peripheral & central chemoreceptors 4. The skin is pale cold and moist increase VC discharge esp. to Cutaneous 5. Decrease volume of urine. 6. Fainting may occur.

Effects of Shock The effect depends upon volume and rate of blood loss It is divided into immediate and delayed Immediate compensatory mechanism 1. Cardiovascular system:- Increase heart rate by increased adrenaline secretion - Hypoxia stimulates Cardioaccelerator centre. - Increase vasoconstrictor discharge 2. Respiratory changes - Increase respiratory rate ,this helps oxygenation of blood and venous return. 3. Contraction of spleen. 4. Blood changes coagulation of blood 5. Renal changes: - Decrease volume of urine - Increase ADH secretion - VC of renal blood vessel lead to renal ischemia & release of renin. 6. Hormonal changes i. Adrenaline & nor adrenaline ii. ACTH iii. Aldosterone: cause Na+ and H20 retention and increases blood volume and ABP to normal iv. ADH : cause VC and increase water reabsorption from renal tubules ABP increase to normal v. Angiotensin II Delayed mechanism 1. Restoration of plasma The aim is to correct the deficiency of the circulating plasma volume: i. Rapid mechanism - Tissue fluid shift - Thirst ii. Slow mechanism - Liver reformed albumin 2. Restoration of RBCs i. Rapid mechanism - Splenic contraction due to adrenaline release and symphathetic stimulation ii. Slow mechanism - By bone marrow