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Original filename: SHOCK _ MODS.pdf
Title: Critical Care Medicine
Author: A.Rsistrar

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Prof. A.S.M. Areef Ahsan
MD(Critical Care Medicine)
MD ( Chest)

Head, Dept. of Critical Care Medicine
BIRDEM General Hospital

Circulatory failure: ‘shock’ DEFINITION:

Shock is a level of oxygen delivery (DO2) that fails to meet
the metabolic requirements of the tissues.
This creates an imbalance between oxygen delivery and
oxygen consumption.
Prolonged oxygen deprivation leads to cellular hypoxia and
derangement of critical biochemical processes at the cellular
level, which can progress to the systemic level
The effects of oxygen deprivation are initially reversible,
but rapidly become irreversible. The result is sequential cell
death, end-organ damage, multi-system organ failure, and
This highlights the importance of prompt recognition and
reversal of shock


Shock is not synonymous with hypotension,
which is often a late manifestation.
 The cardiac output and oxygen delivery may be
critically low, even though the BP remains normal
and the underlying problem should be identified
and treated before the BP falls.



Classification of shock: 3 types
1. Hypovolumic Shock
2. Cardiogenic Shock
3. Distributive Shock
a. Septic
b. Adrenal Crisis
c. Neurogenic (Spinal Shock)
d. Anaphylactic

Hypovolemic Shock

Hypovolemic Shock

Causes of Hypovolemic Shock

 Hemorrhagic
• GI bleed
• Trauma
• Massive haemoptysis
• AAA rupture
• Ectopic pregnancy,
post-partum bleeding

 Non-hemorrhagic
• Vomiting
• Diarrhea
• Bowel obstruction,
• Burns
• Neglect, environmental

Causes of Cardiogenic Shock

Myocardial infarction involving greater than 40 percent of the
left ventricular myocardium,
Right ventricular infarction,
Dilated cardiomyopathies,
Myocardial depression due to advanced septic shock,
Mechanical causes of cardiogenic shock include valvular
defects, ventricular septal defects or rupture, atrial myxomas,
and a ruptured ventricular free wall aneurysm.

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