1 Shock

2 Shock refers to an abnormality of the circulatory system in which there is inadequate tissue perfusion due to a relatively or absolutely inadequate cardiac output.

3 Hypovolemic shock Hypovolemic shock refers to a medical or surgical condition in which rapid fluid loss results in multiple organ failure due to inadequate circulating volume and subsequent inadequate perfusion. Most often, hypovolemic shock is secondary to rapid blood loss (hemorrhagic shock).

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5 Pathophysiology The human body responds to acute hemorrhage by activating the following major physiologic systems: the hematologic, cardiovascular, renal, and neuroendocrine systems.

6 1- The hematologic system activating the coagulation cascade. contracting the bleeding vessels. platelets are activated. → Formation of a blood clot.

7 2- The cardiovascular system increasing the heart rate. increasing myocardial contractility. constricting peripheral blood vessels. redistributing blood to vital organs (brain, heart, and kidneys) and away from skin, muscle, and GI tract.

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9 3- The renal system

10 4- The neuroendocrine system ↑ ADH secretion in → ↑ reabsorption of water and salt

11 Causes Traumatic Related Vascular Related GI Related Pregnancy Related

12 Clinical Presentation  Hypotension.  Rapid pulse.  Cold, pale, clammy skin.  Intense thirst.  Rapid respiration.  Restlessness.  ↓ Urine volume.

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14 Do not rely on systolic BP as the main indicator of shock; this practice results in delayed diagnosis. Compensatory mechanisms prevent a significant decrease in systolic BP until the patient has lost 30% of the blood volume. More attention should be paid to the pulse, respiratory rate, and skin perfusion. Also, patients taking beta-blockers may not present with tachycardia, regardless of the degree of shock.

15 Types of Hypovolemic Shock Hemorrhagic Shock Traumatic Shock Surgical Shock Burn Shock

16 Treatment Three goals exist in the emergency department treatment: (1) maximize oxygen delivery. (2) control further blood loss. (3) fluid resuscitation.

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18 Drug therapy The goals of pharmacotherapy are to reduce morbidity and prevent complications. Drug Category: Antisecretory agents These agents have vasoconstrictive properties.

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21 Follow up Complications:  Neurologic sequelae  Death

22 Prognosis The prognosis is dependent on the degree of volume loss.