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Lecture 4
To develop an understanding of the various types of
• Describe the various types of shock
• Identify the stages of shock and gain an insight into
the pathophysiology
What is Shock?

Shock is a life threatening condition which

happens when the body is not getting enough
blood flow.

This means the cells don’t get enough oxygen to

enable them to work properly, which can lead
to damage to the vital organs.
Stages of shock.
•Compensatory stage

•Progressive stage

•Non compensatory

Anaphylactic Cardiac

Septic Neurogenic
Hypovolemic shock:
also known as haemorrhagic shock
Significant and sudden blood or
fluid loss within your body,
externally or internally.

Can you name some examples of

how this might occur?
Symptoms of hypovolemic shock
• Anxiety
• Blue lips and fingernails
• Shallow breathing
• Dizziness
• Profuse sweating
• Confusion
• Low blood pressure
• Rapid heart rate
• Weak pulse
• Loss of consciousness
Treatment of and management hypovolemic

• Securing airway if needed

• IV access/ fluids
• Prevention of further injury
• Pressure to external injury
• Surgical intervention
Cardiogenic shock
Cardiogenic shock is caused by
the failure of the heart to pump
effectively. It can be due to
damage to the heart muscle,
most often from a large
myocardial infarction.

Other causes include abnormal

heart rhythms, cardiomyopathy,
cardiac valve problems,
ventricular outflow obstruction
(i.e. aortic valve stenosis, aortic
dissection, cardiac tamponade,
constrictive pericarditis,
Symptoms of cardiogenic shock
• Dyspnea
• Chest pain
• Palpitations
• History of cardiac disease
• Pale skin
• Weak pulse
• Delayed capillary refil
• Decreased urine output
Treatment and management of Cardiogenic
• Increase oxygen supply to the heart/ pulse oximetry
• Maximise cardiac output/ cardia monitor
• IV access
• Diuretics
• Catheterisation if ongoing ischemia
• Positive inotropic drugs
Anaphylactic shock

Anaphylaxis is an extreme and severe allergic reaction. This is often

rapid in onset and may cause death.
The cause remains unknown in 32–50% of cases, referred to as
‘idiopathic anaphylaxis’.
Immunoglobulin E binds to the antigen (the material causing the
allergic reaction). This antigen bound immunoglobulin then activates
high-affinity IgE receptors on mast cells and basophils. This then leads
to the release of mediators such as histamines. These mediators
subsequently increase the contraction of bronchial smooth muscles,
trigger vasodilation, increase the leakage of fluid from blood vessels,
and cause heart muscle depression
Anaphylactic shock
• Foods/Additives: • Environmental agents:
Eggs Pollens
Nuts Animal hair

• Diagnostic agents:
Dyes • Drugs:

• Biologic Agents:
Blood • Venoms:
Vaccines Bees
Symptoms of Anaphylaxis
• Skin rash.
• Local oedema around face, lips, eyes.
• Weak rapid pulse.
• Laryngeal stridor, (noisy breathing)
• Wheeze
• Dyspnoea, cough, cyanosis.
Treatment of Anaphylactic shock

• Remove the trigger if possible

• Patient positioning (recovery)
• Adrenaline (epinephrine)
• Anti-histamines
• Steroids
• IV fluid/oxygen

Resuscitation Council
guidelines(2008); NICE guidelines
Neurogenic Shock
The rarest form of shock, neurogenic
shock is caused by sympathetic
nervous system disruption resulting
from: physical injury to the central
nervous system, especially high
thoracic spinal injury (T6 level or
higher)or damage to the brainstem’s
vasomotor centre

Emotional trauma, in which high

levels of fear, anxiety, and stress cause
sudden loss of autonomic nervous
system (ANS) control, leading to
massive vasodilation

Vagus nerve stimulation, which may

override the ANS, causing
parasympathetic tone to dominate
and resulting in vasodilation.
Neurogenic shock

• Spinal cord injury (Above T6)
• Spinal anaesthesia
• Drugs
• Emotional stress
• Pain
• CNS dysfunction
Symptoms of
neuropathic shock
Treatment of neuropathic shock

• Prevent further Spinal cord injury

• Reverse any causes
• Control breathing
• Give fluids
• Give Inotropes
Septic shock (sepsis)
Septic shock is an inflammatory
state resulting from a
systematic response to
bacterial infection leading to
acute multiple organ failure.
Septic shock
• Gram negative • Exogenous sources:
Hospital environment
• Gram positive Staff
• Aerobes • Endogenous sources:
• Anaerobes Skin
• Fungi GI Tract
Resp. Tract
• Viruses
Symptoms of Septic Shock

• Fever or abnormally low body temperature

• Rapid breathing
• Rapid heartbeat
• Confusion (changes in mental state)
• Low BP
• Skin discolouration
• Dyspnea
• Thombocytopenia
• Chills
• Pneumonia
Septic shock (Treatment)

• Restore adequate intravascular volume via IV fluids.

• Give 02.
• Identify and control source of infection via bacterial screening.
• Administer appropriate antibiotics.
• Remove infection if possible, i.e. central line, cannula, urinary
catheter etc.
Sepsis Six

•high flow oxygen
Supportive therapy

• Give adequate ventilation and oxygenation.

• Maintain/restore adequate perfusion of tissues – medication –
contractility – reduce cardiac workload.
• Reverse metabolic acidosis.