Dr.Aye Aye ChitDr.Aye Aye ChitC.S, LecturerC.S, LecturerMU I, MGH.MU I, MGH.

DefinitionDefinition

Shock is a physiological state Shock is a physiological state characterized by a significant systemic characterized by a significant systemic reduction in perfusion resulting in reduction in perfusion resulting in decreased tissue oxygen delivery.decreased tissue oxygen delivery.

Causes / ClassificationCauses / Classification

1.1. Hypovolumic shockHypovolumic shock2.2. Cardiogenic shockCardiogenic shock3.3. Neurogenic shockNeurogenic shock4.4. Analphalatic shockAnalphalatic shock5.5. Septic shockSeptic shock6.6. Obstructive shockObstructive shock

IntroductionIntroduction

Imbalance between OImbalance between O2 2 demand and demand and

supply.supply. Inadequate tissue perfusion leading to Inadequate tissue perfusion leading to

cellular hypoxia.cellular hypoxia. Derangement of critical biochemical Derangement of critical biochemical

processes such as cell membrane ion processes such as cell membrane ion pump dysfunction, intracellular edema, pump dysfunction, intracellular edema, leakage of IC contents to EC space. leakage of IC contents to EC space.

Initially reversible and rapidly irreversible Initially reversible and rapidly irreversible cell death and organ demage.cell death and organ demage.

The mortality remains high. The mortality remains high. Septic shock -35-40 %Septic shock -35-40 % Cardiogenic shock -60-90 %Cardiogenic shock -60-90 % Hypovolumic shock -variableHypovolumic shock -variable

ManagementManagement

Initial assessment – Initial assessment – pulse,BP,RR,Temp,urine output.pulse,BP,RR,Temp,urine output.

Resuscitation - 0 care of ABC Resuscitation - 0 care of ABC Urgent investigation – ECG and cardiac Urgent investigation – ECG and cardiac

enzymes, Hb,urea and electrolytes, G enzymes, Hb,urea and electrolytes, G & & M, arterial blood gas , blood culture.M, arterial blood gas , blood culture.

Appropiate treatment of underlying Appropiate treatment of underlying causes.causes.

1.1. Hypovolumic shockHypovolumic shock

Care of A – keep the air way patent.Care of A – keep the air way patent. Care of B – give 100% oxygen via face Care of B – give 100% oxygen via face

mask.mask. Care of C – restore circulation by blood Care of C – restore circulation by blood

or crystalloids depend on or crystalloids depend on the the cause. cause.

2.2. Cardiogenic shockCardiogenic shock

Bed restBed rest AnalgesiaAnalgesia Asprin and thrombolictic therapy in AMIAsprin and thrombolictic therapy in AMI Treat heart failure Treat heart failure Treat arrhythmiasTreat arrhythmias

3.3. Septic shockSeptic shock

FluidsFluids Antibiotics and surgeryAntibiotics and surgery Inotropes – Dopamine, Dobutamine, Inotropes – Dopamine, Dobutamine,

Adrenalin, NoradrenalinAdrenalin, Noradrenalin

4.4. Analphylatic shockAnalphylatic shock IV fluidsIV fluids AdrenalinAdrenalin AntihistamineAntihistamine HydrocortisoneHydrocortisone