1) Most common type of shock in children worldwide.

2) Body’s first action to maintain the Cardiac Output?

3) Common forms of Distributive Shock? 4) Causes of Obstructive Shock? 5) 3 factors that determine Stroke Volume?

RECOGNITION OF SHOCK

Dr.Manoj Prabhakar.M, Resident (Dept of Pediatrics)

THIS PART DISCUSSES THE FOLLOWING

Definition of shock

Pathophysiology of shock

Etilogy and signs of the 4 most common types of shock.

DEFINITION OF SHOCK

A critical condition that results from inadequate tissue delivery of O2 and nutrients to meet the tissue metabolic demands.

SHOCK CAN RESULT FROM

Inadequate blood volume or oxygen carrying capacity

Inappropriate distribution of blood volume and flow

Impaired cardiac contractility Obstructed blood flow.

PATHOPHYSIOLOGY OF SHOCK

COMPONENTS OF TISSUE OXYGEN DELIVERY

Adequate tissue O2 delivery depends onSufficient blood flow to the tissuesAppropriate distribution of blood flow to

the tissues.

STROKE VOLUME Amount of blood ejected by the heart with

each beat. Determined by 3 factors:

FACTOR CLINICAL DEFINITION

Preload Volume of blood present in the ventricle before contraction.

Contractility

Afterload Resistance against which the ventricle is ejecting

COMPENSATORY MECHANISMS

Tachycardia Increase in systemic vascular resistance Increase in strength of cardiac

contraction Increase in venous smooth muscle tone

EFFECT ON BPSystolic BP may initially remain

normal or even slightly elevated.

Pulse pressure is often narrrowed.

COMMON SIGNS Compensatory

MechanismArea Sign

Increased heart rate Heart Tachycardia

Increased SVR

SkinColdPaleMottleddiaphoretic

Peripheral Circulation

Delayed capillary refill

PulsesWeak peripheral pulsesnarrow pulse pressure

Increased renal and splanchnic

vascular resistance

Kidney Oliguria

Intestine Vomiting, ileus

IDENTIFICATION OF SHOCK BY TYPE

HYPOVOLEMICDISTRIBUTIVECARDIOGENICOBSTRUCTIVE

1.HYPOVOLEMIC SHOCK

• Causes :• Diarrhea• Vomiting• Hemorrhage• Inadequate fluid intake• Osmotic diuresis• Large burns

Airway Typically patent Breathing Tachypnea

Circulation

TachycardiaWeak or absent peripheral pulsesDelayed capillary refillingOliguriaCold pale skin

HYPOVOLEMIC SHOCK

2.DISTRIBUTIVE SHOCK Abnormal distribution of blood flow in the small

blood vessels results in inadequate supply of blood to the body's tissues and organs

Most common forms of distributive shock are:SEPTIC SHOCKANAPHYLACTIC SHOCKNEUROGENIC SHOCK

SIGNS OF DISTRIBUTIVE SHOCK SEPTIC SHOCK:

Fever or hypothermia Altered WBC

ANAPHYLACTIC SHOCK: Anxiety or agitation Nausea & vomiting Urticaria Angioedema Hypotension Tachycardia

Neurogenic Shock :

- Hypotension with a wide pulse pressure - Normal heart rate or bradycardia.

Airway Usually patent

Breathing Quiet tachypnea

Circulation

TachycardiaBounding peripheral pulsesBrisk or delayed capillary refillWarm and flushed skin ( Warm shock )Pale and mottled skin ( cold shock )

DISTRIBUTIVE SHOCK

3) CARDIOGENIC SHOCK Inadequate circulation of blood due to

primary failure of the ventricles of the heart to function effectively

Causes It can be due to damage to the heart muscle

Congenital heart disease Myocarditis Cardiomyopathy Arrhythmias Poisoning due to drug toxicity Myocardial Injury

CARDIOGENIC SHOCK

Airway Usually patent

BreathingTachypneaIncreased respiratory effort

Circulation

TachycardiaSigns of congestive cardiac failureCyanosisCold and pale skin

4.OBSTRUCTIVE SHOCK Shock associated with physical

obstruction of the great vessels or the heart itself.

CARDIAC TAMPONADE-Muffled heart soundsPulsus paradoxusDistended neck veins

TENSION PNEUMOTHORAX:Tracheal deviation towards contralateral

sideHyper resonant on affected sideDiminished breath sounds on affected side

OBSTRUCTIVE SHOCK

DUCT DEPENDED LESIONSHigher pre ductal vs post ductal

blood pressureAbsence of femoral pulsesMetabolic acidosis

OBSTRUCTIVE SHOCK

MASSIVE PULMONARY EMBOLISMTachycardiaCyanosisHypotensionChest pain

OBSTRUCTIVE SHOCK

RECOGNITION OF SHOCK FLOWCHART

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