SHOCK- DEFINING MOMENTS

SHOCK
1. DEFINITION
The chief cause leading to shock is a lack of tissue
perfusion with oxygenated blood.
-Shock is low blood pressure, which is referred to as hypotension, but it also shows a continued inadequate tissue perfusion with O2.
-Thus the metabolic requirements of the tissues are not met.
-These requirements include supply of nutrients including O2, and removal of waste products.
1.1 If shock is treated in time cellular injury is limited.
1.2 If not treated irreversible widespread cell injury occurs
leading to multiple organ dysfunction and failure.

*Overview
-Shock is a clinical syndrome resulting from inadequate tissue perfusion.
-The decrease of delivery of requirement and the cellular unmet demand lead to cellular injury.
-Inadequate oxygen delivery is the main cause of shock states, the clinical manifestations of shock are caused by end organ dysfunction because of lower perfusion in spite of the body’s compensatory response.
-The continuing insufficient supply of oxygen to cells following sympathetic and neuron-endocrine interventions is cause of the symptoms and signs of shock.
-Timely restoration of perfusion and oxygen delivery usually reverse the shock state.
However the persistence or progression of shock may occur as a result of an ongoing undiagnosed perfusion defect or irreversible cellular injury, or a combination of the two phenomena.
-In addition, there is substantial clinical and laboratory evidence suggesting that cellular injury leads to production of pro-inflammatory chemical mediators that may further compromise perfusion through functional and structural changes in the microvasculature.
-This form of secondary injury further reduces perfusion, creating a vicious cycle of cellular injury leads to impaired perfusion that further increases cellular injury.
-Last in total body hypo-perfusion there is activation of potent inflammatory cells that may lead to the systemic inflammatory response syndrome (SIRS).
-It is suggested that persistence of SIRS, through the total body cellular dysfunction, may be the cause for the development of the multiple organ dysfunction syndrome (MODS).*

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