Brief description of Shock

1. 1
PATHOPHYSIOLOGY
CLINICAL FEATURES
MANAGEMENT
Dr Vipin V Nair
SHOCK

2. SAMUEL V
GROSS, 1872
“SHOCK IS THE MANIFESTATION OF
THE RUDE UNHINGING OF THE
MACHINERY OF LIFE”
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3. HISTORICAL PERSPECTIVE
• Ambroise Paré (1510) – Fluids to injured patients
• ‘Shock’ – 1743 – act of impact/ collision
• Crile (1899) – Importance of measuring BP
• Claude Bernard – Milieu intérieur
• Walter B. Cannon – Homeostasis
•Alfred Blalock (1934) – 4 categories of shock
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4. Definition
 Systemic – global
phenomenon
 Hypoperfusion (relative/
absolute)
 Inadequate cellular
respiration
 Anaerobic, dysfunction
 Body responses thereof
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A systemic state of tissue hypo-perfusion, which is
inadequate for normal cellular respiration

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SHOCK INDUCED VICIOUS CYCLE

9. CELLULAR
PATHOPHYSIOLOGY
COMPENSATION/
DYSFUNCTION/
DEATH
9

10. INFLAMMATORY
&
IMMUNE
RESPONSE
10
Pro-inflammatory Anti-inflammatory
IL-1α/ẞ IL-4
IL-2 IL-10
IL-6 IL-13
IL-8 IL-1Ra
IFN-ϒ PGE2
TNF-α TGF-β
PAF
TNFR- I/II

11. INFLAMMATORY
&
IMMUNE
RESPONSE
• MODS
• Counter-regulatory immune response
• Delayed MOF
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12. Clinical
Features &
Management
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13. Severity of
shock
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Compensated shock
Decompensation
•Mild shock
•Moderate shock
•Severe shock
Unresuscitable Shock
MOF

14. Hemorrhagic
shock
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15. Hemorrhagic shock
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Most common
cause of shock in
the surgical or
trauma patients
Young patients vs
elderly patients

16. Septic
Shock
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18. Cardiogenic Shock
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20. Obstructive Shock
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22. Neurogenic Shock
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25. Management
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34. Stablize
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