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APPROACH TO SHOCK

D R. N O R A Z I L AWAT I M O H D N AW I
14.5.2016

SHOCK
an acute clinical syndrome initiated by ineffective
perfusion, resulting in severe dysfunction of
organs vital to survival.
shock is not just hypotension, but that shock
represents hypoperfusion of end organs.
Normotensive patients can often suffer from
shock.

PATHOPHYSIOLOGY OF SHOCK

SHOCK STAGES

CLASSIFICATION
types

physiology

examples

hypovolemic

Decreased circulatory
volume

Hemorrhage or fluid
loss

cardiogenic

Impaired heart pump


function

Acute coronary
syndrome, valve
failure, dysrhythmias

distributive

Pathologic peripheral
blood vessel
vasodilation

Sepsis, anaphylaxis,
neurogenic

obstructive

Non-cardiac
obstruction to blood
flow

Pulmonary embolus,
tension
pneumothorax,
tamponade

CARDIOGENIC SHOCK
Impaired ability of the
heart to pump blood
Pump failure of the
right or left ventricles
Most common cause is
anterior MI
Occurs when > 40%
ventricular mass
damage
Mortality rate 80% or
more

OBSTRUCTIVE SHOCK
Obstructive shock is associated with any extracardiac
process that impedes forward circulatory flow.
The two main types of obstructive shock are
those that block cardiac filling (e.g., tension
pneumothorax, cardiac tamponade)
those that cause increased cardiac (right or left sided)
afterload (e.g., aortic dissection, massive pulmonary
embolus) .
Because obstructive shock impedes forward flow, cardiac
output is greatly diminished, and the clinical signs and
symptoms can resemble those of hypovolemic and
cardiogenic shock, depending on the specific cause

DISTRIBUTIVE SHOCK
Distributive shock is a form of shock that is
associated with a hyperdynamic state with a high
cardiac output and low systemic vascular
resistance.

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