Shock - DNB Orthopaedics MS Orthopedics MRCS Exam GUIDE -

DNB Orthopaedics  MS Orthopedics  MRCS Exam GUIDE -

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Monday 2 April 2018


  • clinical syndrome that develops when oxygen delivery is inadequate to meet the metabolic requirement of the tissue due to some form of acute circulatory failure
Image result for shock
  • five broad categories
    • Hypovolaemic shock : due to conditions causing major reduction in blood volume
      • internal or external hemorrhage, severe burns, dehydration, ketoacidosis
    • Cardiogenic shock : due to conditions causing any form of heart failure
      • MI, cardiac contusion
    • Obstructive shock : due to conditions causing any form of obstruction to circulation
      • pulmonary embolism, cardiac tamponade
    • Anaphylactic shock : allergens triggering vasodilatation
    • Septic shock : severe infection or inflammation causing capillary leak or inappropriate vasodilatation

Hypovolaemic shock
  • most common cause of shock in trauma patient
  • leads to
    • hemostasis of circulation
    • decrease in ventilation
    • decrease in metabolic functions
  • Clinical features
    • sweating
    • unconsciousness, confusion, decreased responsiveness, irritability
    • tachypnoea
    • hypotension <100mm Hg
    • tachycardia with low volume pulse >100/min
    • cold cyanosed peripheries
    • poor urine output <30ml/hr
  • Treatment
    • resuscitation – crystalloid solution – large bore I/v line- RL solution
    • monitor with urine output – goal of 0.5mL/kg/hr in adults
    • also CVP, pulmonary artery pressure
    • severe degree of shock – venous constriction – I/v cut down of saphenous or cubital veins needed
  • Classes
Classes of Shock

Blood loss (L)
750 -1500
1.5 - 2
>2 l
Blood volume loss %
15 -30
30 -40
Pulse rate
Urine output (ml/hr)

  • Blood infusion combined with crystalloid infusion at a ration of 3:1 is recommended
  • RBC concentrate if massive bleeding suspected
  • identify the bleeding source when volume restoration have been started
    • Chest, pelvis, cervical spine, head radiographs
    • USG pelvis
  • treat component deficiencies if needed – thrombocytopenia if levels go below 50,000/ul – FFP if hypofibrinogemia, factor V and VIII
  • large volume infusion – leads to hypothermia – coagulation dysfunction – warming of patients
  • Complications
    • inadequate tissue perfusion – cellular dysoxia – multiple organ failure
      • intra cerebral bleeding – confusion , coma
      • ARDS
      • myocardial depression
      • liver failure with hyperbilirubinaemia
      • GIT mucosal damage, bleeding into GIT, ileus
      • skin hemorrhage, infarct
      • gangrene

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