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Shock | Types And Mechanisms of Shock | Dr Najeeb
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▬▬▬▬▬▬▬▬▬▬ Contents of this video ▬▬▬▬▬▬▬▬▬▬
0:00 Types, Mechanisms & Stages of Shock
Definitions of different types of shocks;
HYPOVOLEMIC SHOCK
CARDIOGENIC SHOCK
DISTRIBUTIVE SHOCK & its 3 types:
1-Anaphylactic Shock
2-Neurogenic Shock
3-Septic Shock
22:22 OBSTRUCTIVE SHOCK
CAUSES of HYPOVOLEMIC SHOCK
1-HEMORRHAGE:
External Hemorrhage
Internal Hemorrhage
2-LOSS OF PLASMA:
Exfoliative Dermatitis
3-LOSS OF FLUIDS & ELECTROLYTES:
Diarrhea & Vomiting
Polyuria: e.g., Diabetic Ketoacidosis
Excessive Sweating
3rd Spacing; Ascites, Bowel Obstruction, Acute Pancreatitis,
36:20 CARDIOGENIC SHOCK
1-ARRHYTHMIAS:
Tachyarrhythmia & Bradyarrhythmia
2-TRUE PUMP FAILURE:
Massive Myocardial Infarction
Cardiomyopathies
CARDIOMYOPATHIES
3-SEVERE VALVULAR DYSFUNCTION:
Valvular Regurgitation; like Mitral Valve Regurgitation, Aortic Valve Regurgitation.
4-RUPTURE OF VENTRICULAR SEPTUM or FREE WALL
53:09 DISTRIBUTIVE SHOCK:
1-Neurogenic Shock:
Vasomotor Center Failure/Depression
2-Anaphylactic Shock
3-Septic Shock
1:02:35 Acute Adrenal Insufficiency
1:21:21 OBSTRUCTIVE SHOCK:
1-Cardiac Tamponade
2-Tension Pneumothorax
3-Massive Pulmonary Embolism
4-Atrial Myxoma
5-Left Atrial Mural Thrombus
1:15:20 Syncope; Vasovagal shock.
Outline of STAGES OF SHOCK:
1-Non-Progressive Compensated Stage
2-Progressive Stage of Shock
3-Refractory Shock/Irreversible Shock
4-NON-PROGRESSIVE COMPENSATED STAGE SHOCK; in detail:
1-Sympathetic Autonomous Nervous System (SANS):
Chemoreceptors, Baroreceptors, Vasomotor Center, Vasoconstriction & Arterioloconstriction
Cardiac Output (CO) & Systolic Blood Pressure (SBP), Total Peripheral Resistance (TPR) & Diastolic Blood Pressure (DBP)
Compensatory mechanisms try to stabilize the blood pressure.
2-Renin-Angiotensin-Aldosterone Axis System (RAAA):
Reduced renal perfusion, Renin release, Angiotensin-1, Angiotensinogen (ATG), Angiotensin-2 (AT-2)
Why more Renin is released?
Arterioloconstriction leads to increased TPR; DBP stabilized.
AT-2 act on Adrenal Cortex; ZG will release Aldosterone; salt & water retained; increased blood volume;
SBP stabilized.
3-ADH(Vasopressin
4-REVERSE STRESS-RELAXATION of Circulatory System
5-FLUID SHIFT (Interstitial to Vascular)
1:52:07 PROGRESSIVE STAGE OF SHOCK:
Compensatory Mechanisms are exhausted and are failing; deterioration starts.
Fight b/w Vasoconstrictor & Vasodilator mechanisms.
"Peripheral tissues will become resistant to the compensatory vasoconstrictor mechanisms & start vasodilating".
Endothelial Cells are injured; NO is released which acts as Vasodilator and cardio depressant.
Lactic Acidosis
Disseminated Intravascular Coagulation (DIC)
2:06:45 REFRACTORY IRREVERSIBLE STAGE:
"Cells & tissues start committing suicide".
1-Na+K+ ATPases are not working
2-Lysosomal Membrane breaks down
3-ATP into Adenosine; raised uric acid in the blood.
2:16:36 Post mortem findings in these patients.
SEPTIC SHOCK & its types:
1-Bacteremia
2-Septicemia
3-Endotoxemia
Differences b/w in Gram +ve & Gram -ve bacteria.
Differences b/w Endotoxins & Exotoxins.
4-Pyemia
5-Empyema
6-Abscess
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