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
