2. Definition
âą Shock is the term used to describe acute circulatory
failure with inadequate or inappropriately
distributed tissue perfusion resulting in generalized
cellular hypoxia and/or an in ability of the cells to
utilize oxygen.
3. Causes of shock
ï¶ Abnormalities of tissue perfusion may result from:
ï failure of the heart to act as an effective pump
ï mechanical impediments to forward flow
ï loss of circulatory volume
ï abnormalities of the peripheral circulation.
4.
5.
6. CLINICAL FEATURES OF SHOCK
Hypovolaemic shock
ï¶ Inadequate tissue perfusion:
(a) Skin â cold, pale, slate-grey, slow capillary refill, âclammyâ
(b) Kidneys â oliguria, anuria
(c) Brain â drowsiness, confusion and irritability.
ï¶ Increased sympathetic tone:
(a) Tachycardia, narrowed pulse pressure, âweakâ or âthreadyâ pulse
(b) Sweating
(c) Blood pressure â may be maintained initially (despite up to a 25%
reduction in circulating volume if the patient is young and fit), but
later hypotension supervenes.
ï¶ Metabolic acidosis â compensatory tachypnoea.
8. ï¶Obstructive shock
âą Elevated JVP.
âą Pulsus paradoxus and muffled heart sounds in
cardiac tamponade.
âą Signs of pulmonary embolism
9. ï¶Anaphylactic shock
Signs of profound vasodilatation:
(a) Warm peripheries
(b) Low blood pressure
(c) Tachycardia.
â Erythema, urticaria, pallor, cyanosis.
â Bronchospasm, rhinitis.
â Oedema of the face, pharynx and larynx.
â Hypovolaemia due to capillary leak.
â Nausea, vomiting, abdominal cramps, diarrhoea.
10. âą Sepsis, severe sepsis and septic shock
â Pyrexia and rigors, or hypothermia (unusual).
â Nausea, vomiting.
â Vasodilatation, warm peripheries.
â Bounding pulse.
â Rapid capillary refill.
â Hypotension (septic shock).
â Occasionally signs of cutaneous vasoconstriction.
â Other signs:
(a) Jaundice
(b) Coma, stupor
(c) Bleeding due to coagulopathy (e.g. from vascular puncture
sites, GI tract and surgical wounds)
(d) Rash and meningism
(c) Hyper-, and in more severe cases hypoglycaemia
11. Assessment of tissue perfusion
â Pale, cold skin, delayed capillary refill and the
absence of
visible veins in the hands and feet indicate poor
perfusion.
â Metabolic acidosis with raised lactate
concentration may suggest that tissue perfusion is
sufficiently compromised to cause cellular hypoxia
and anaerobic glycolysis. dysfunction.
â Urinary flow is a sensitive indicator of renal perfusion
and haemodynamic performance