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 for oxygen and substrate leads 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 - Compressive 4) Septic - 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 ;