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HAEMORRHAGE

AND

SHOCK

Presented by:- Dr. Arjun Singh (P.G.First year)

Guided by:- Dr. Sanjeev Kumar (Professor and Head) Dept. of Oral & Maxillofacial Surgery

CONTENTS

Introduction Definition Classification Stages of shock

Definition

Shock is a life threatening situation. In

most cases it is due to poor tissue perfusion with impaired cellular

metabolism, manifested in turn by

serious pathophysiological abnormalities.

Bailey and Love

Shock may be defined as “….an acute

generalized, inadequate perfusion of

critical organs that, if continued, will

produce serious pathophysiological consequences”. FONSECA

Shock is the clinical syndrome that

results

from

inadequate

tissue

perfusion. Irrespective of cause, the

hypoperfusion-induced

imbalance

between the delivery of and

requirements

substrate

for

leads

oxygen

and

to

cellular

dysfunction.

HARRISON

―Shock is a condition in which

circulation fails to meet the

nutritional needs of the cells and

fails to remove the metabolic waste

products’’. S. DAS

  • I. Classification of shock

(Somen Das)

Haematogenic or Hypovolaemic shock Traumatic shock

Neurogenic shock

Cardiogenic shock Septic shock

Miscellaneous types

a) Anaphylactic shock

II. Classification of shock

(Harrison)

1) Hypovolaemic Shock

2) Traumatic shock 3) Cardiogenic shock - Intrinsic

4) Septic

  • - Compressive

  • - Hyperdynamic

- Hypodynamic

5) Neurogenic shock

6) Hypoadrenal Shock

1)Primary or Initial shock

Is a transient and usually benign vasovagal attack resulting

from sudden reduction of venous return to the heart caused by

neurogenic vasodilatation and consequent peripheral pooling of the blood.

-It can occur immediately following Trauma Severe pain Emotional overreaction due to

  • a) Fear

  • b) Sorrow and surprise

  • c) Sight of blood

Clinically Patient develops,signs and symptoms similar to that of syncope

  • - Unconsciousness

  • - Weakness

  • - Sinking Sensation

  • - Pale and Clammy limbs

  • - Weak and rapid pulse and

  • - Low Blood Pressure

……Primary shock can be labelled as a severe form of syncope.Lasting few seconds to minutes.

2) Secondary (or) True shock

……occurs due to haemodynomic derangements with hypoperfusion of the

cells, this type of shock is the ‘true shock’.

STAGES OF SHOCK

According to Winters, the different manifestations of

shock occurs in 3 stages, namely:

-Initial stage or Compensated shock (Non progressive)

-Decompensated shock (Progressive)

-Irreversible shock

Initial stage or Compensatory stage or Non

progressing stage

Slight

reduction

in

the

circulation

blood

volume…….

does

not

produce

severe

symptoms

or

manifestations

Progression

mechanisms

compensated

by

compensatory

Blood pressure and cardiac output maintained by various negative feedback control mechanisms like ;