PATHOPHYSIOLOGY ON TYPES OF SHOCK

External and
Vasodilation HYPOVOLEMIC Internal Loss
SHOCK

causes causes  Loss of whole blood

 Vasodilation
(SIRS/sepsis, (Trauma or surgery and
Anaphylaxis and Loss Gastrointestinal bleeding)
of sympathetic Absolute  Loss of plasma (Thermal
stimulation) Relative
Hypovolemia Hypovolemia injuries and Large lesions)
 Increased capillary  Loss of other body fluids
membrane
(Severe vomiting or
permeability
 Decreased colloidal diarrhea,massive diuresis or
leads to Hemothorax)
osmotic pressure
(Severe sodium
depletion) Decreased
circulating volume

leads to

Decreased venous
return

leads to
 Decreased BP
Decreased stroke  Increased pulse
volume  Increased
respirations
causes


Decreased cardiac
output Decreased urinary
output

leads to

Decreased cellular
oxygen supply

causes

Ineffective tissue
perfusion

 Skin cool and pale

causes  Change in level of
consciousness
Legend:
Impaired cellular
Precipitating factors – metabolism

Predisposing factors –

Etiology -

Disease Process –

Signs and Symptoms -

Precipitating Factors
Predisposing Factors
 Food
 a previous  Food additives
anaphylactic reaction ANAPHYLACTIC  Diagnostic agents
 allergies or asthma SHOCK  Biologic agents
 a family history of  Environmental agents
anaphylaxis  Drugs
 history of atopy  Venoms
 Physical
 Latex

Non-
Immunologic immunologic
stimulation stimulation

causes causes  Lump in

throat
 Cough
Activation of  Dyspnea
 Pruritis biochemical  Dysphagia
 Erythema mediators
 Hoarseness
 Urticaria causes causes
 Stridor
 Angioedema causes  Wheezing
Peripheral Increased Constriction of  Rales and
vasodilation capillary smooth muscle rhonchi
permeability

leads to leads to leads to

leads to

 Hypotension
Decreased circulation Bronchoconstriction Laryngeal edema
 Tachycardia
volume
 Decreased
cardiac index
 Decreased Decreased Oxygenation
right atrial Decreased venous return
pressure
 Decreased
pulmonary
occlusion Decreased stroke volume
pressure
 Decreased
systemic Decreased cardiac output
resistance

Decreased cellular
oxygen supply
 Restlessness
 Apprehension
 Anxiety
 Dizziness
 Headache Ineffective tissue
 Decreased level perfusion
of consciousness

Impaired cellular
metabolism
Predisposing Factors Precipitating Factors

 Male (in 20s and  Spinal cord injury/trauma

<65 years old)  Car accidents
 Neurologic NEUROGENIC  Sport injuries causing
impairment SHOCK trauma to the spine
 Falls
 Altered mobility
 Acts of violence
 Cognitive  Medications that affect
impairment the autonomic nervous
 Having a bone or system,
joint disorder  Improper administration
of anesthesia to the
Disruption of spinal cord
sympathetic
nervous
system

 Warm, dry skin

 Hypothermia
 Poikitothermia.
causes

Inhibition of the baroreceptor

Impaired thermo regulation Loss of sympathetic tone response
leads to leads to

• Bradycardia
leads to

 Hypotension Massive peripheral vasodilation

 Decrease in systemic
Venous and arterial vascular resistance
vasodilation  Relative hypovolemia
and pooling of blood
in the venous circuit

 Decrease in end diastolic Decreased venous

volume or preload return

Decreased stroke
volume

Decreased cardiac
output

Decreased cellular oxygen supply

Decreased tissue Risk of deep vein thrombosis

perfusion (DVT)

 Change in mental
status Impaired cellular
 Decreased urinary metabolism
output
 GI: Paralytic ileus
Predisposing Factors Precipitating Factors

 Septic shock occurs most  Diabetes

often in the very old (>55  Diseases of the
years old) and the very SEPTIC SHOCK genitourinary system,
young people (<2 years biliary system, or
intestinal system
old).
 Diseases that weaken the
 Increasing life support for immune system, such as
high risk patients AIDS
 Disseminated malignancy  Indwelling catheters
 Genetic Defects (those that remain in
 Impaired immunity place for extended
Invading periods)
microorganisms  Leukemia
Systemic  Long-term use of
inflammatory antibiotics
 Decreased left response  Surgical and traumatic
ventricular wounds
stroke work  Surgical and invasive
diagnostic procedures
index
 Immunosuppressive
therapy
causes causes causes

Myocardial
depression Activation of Activation of
Endothelial
biochemical, CNS and
damage
humoral, and cellular Endocrine
mediators systems
Peripheral
vasodilation

 Increased cardiac Increased capillary

Selective Hypermetabolic
Microvascular vasoconstriction state
output and Membrane thrombosis
cardiac index permeability
 Decreased
systemic vascular
resistance  Increased
heart rate
 Wide pulse
pressure  Decreased
Maldistribution of urinary
 Full, bounding blood volume output
pulse
 Decreased
 Pink, warm, Increased cellular
PaO2
flushed skin oxygen demand
 Decreased
 Decreased right
Decreased cellular PaCO2
atrial pressure Bioenergetic
(early) or
 Decreased failure oxygen supply
decreased
pulmonary artery
PaCO2 (late)
occlusion
pressure
 Decreased blood
pressure Increased mixed Ineffective  Increased
or central venous Tissue perfusion respiratory rate
oxygen saturation (early)
 Decreased
respiratory rate
(late)
Impaired Cellular  Crackles
metabolism  Change in
sensorium
 Decreased
HCO3