State of inadequate perfusion to the vital organs of the body
Initially Hypoxic & Metabolic effects of Hypoperfusion cause Reversible cellular injury, persistence of shock eventually causes Irreversible cellular injury and can result in death of pt.


Hypovolemic shock: hemmorhage, fluid loss from fistula, burn, diarrhea

Cardiogenic shock: arrythmia, heart failure, infarction, cardiomyopathy, valvular stenosis and regurgitation, cardiac temponade; Failure of myocardial pump owing to intrinsic myocardial damage, extrinsic pressure, or obstruction to outflow

Distributive shock due to decreased peripheral vascular resistance and peripheral pooling:

Septic shock: Systemic Microbial Infection. Mostly Gram -ve Infection/Sepsis (Endotoxic Shock).

But, can occur with Gram +ve and Fungal infections; endothelial activation/injury; leukocyteinduced damage; disseminated intravascular coagulation; activation of cytokine cascades

Anaphylactic shock - Initiated by generalized IgE-mediated hypersensitivity response

Neurogenic shock: eg anesthetic, spinal cord transection, trauma, emotional stress

Septic shock

Endotoxins are bacterial wall lipopolysaccharides (LPS). All the hemodynamic effects of septic shock can be produced by injection of LPS alone.

LPS - LPS binding protein – CD14 receptor – TLR-4 - activates Monocytes, Macrophages, neutrophils which by production of TNF & IL-1, induce production of other Cytokines from endothelial cells (cytokine cascade) , which

Systemic vasodilation (Hypotension), Diminished Myocardial contractility, Widespread endothelial injury, Activation of coagulation system culminating in DIC.

SIRS( systemic inflammatory response syndrome)

Pulse greater than 90 beats per minute
Body temperature less than 36 or greater than 38°C
RR greater than 20 breaths per minute or, PaCO2 less than 4.3 kPa (32 mm Hg)
WBC count less than 4000 cells/mm³ or greater than 12000 cells/mm³ or the presence of greater than 10% immature neutrophils( left shift)
SIRS+ infection = sepsis
Sepsis + DBP less than 60 mmHG= septic shock



Neurohumoral mechanisms help maintain CO & BP. These are: Baroreceptor reflexes, Catecholamines, RAAS/ADH.
This results in Tachycardia, Peripheral vasoconstriction, Renal conservation of fluid. Skin vasoconstriction causes coolness and pallor of skin.
(In Septic shock the due to vasodilation skin may feel warm and flushed).
Coronary & Cerebral vessels are less responsive to above mechanisms and hence maintain their blood flow.

In this stage there is widespread HYPOXIA leading to Anaerobic glycolysis with excessive production of lactic acid.. Lactic Acidosis lowers pH and blunts the above Vasomotor Response.—so, the arterioles dilate and blood begins to pool in microcirculation. This reduces CO. Also, exposes endothelial cells to injury and subsequent development of DIC.
Hypoxia to Brain makes pt. Confused, and to kidney causes decline in UO
Failure of Multiple Organs eg. Brain, heart, kidneys, lungs, adrenals, GIT, liver.


Lysosomal enzyme leakage from widespread cell injury further aggravating shock with
myocardium dysfunction
Ischemic injury of bowel mucosa causes bacterial transmigration
ATN may lead to complete renal shutdown
MODS: multiorgan dysfunction syndrome
with almost inevitable death.


BRAIN: Changes of ischemic encephalopathy
Heart: sub-endocardial ischaemia, Coagulation necrosis, contraction band necrosis
Kidney: ATN
Lungs: ARDS aka shock lung or non cardiogenic pulmonary edema
GI: mucosal necrosis, hemorrhagic enteropathy
Liver: fatty change, hemorrhagic necrosis.


  1. copy from books?I see the diagrams are the same from the books

  2. At the Kidney Transplant Network we assist those individuals worldwide who need a transplant. This includes Kidney, Liver, Heart, Stomach, and Lung Transplants. This is accomplished by pro-actively going out in the “general public” and locating those individuals who want to donate an organ. Thru collective efforts we utilize cutting edge technology, Social Media, Referrals, Networking, Non-Profit Organizations, Private & Public Hospitals, Clinics, Hospices, and private donors. The Kidney Transplant Network focus is to pro-actively contact those individuals who are interested in donating an organ. You can change a "Life" thru donation so start today!!

  3. mbbs in Philippines
    Every year, almost 8000 foreign students take admission in Philippines Medical universities and out of which around 50% are Indian students. The standard of education in Philippines universities is well known around the world. Thousands of doctors from these medical universities are sent to various countries like USA and UK every year. There are around 2299 higher educational institutions and 40 medical colleges. The main benefits of pursuing MD degree from

    Top Medical Colleges in Philippines :


    Top Searched Topics on MBBS in Philippines

    study mbbs in philippines
    philippines medical colleges list
    best medical colleges in philippines for indian students
    philippines medical colleges
    best medical colleges in philippines
    mci approved medical colleges in philippines

    for more information contact us : +91 90329 55688

  4. UV GULLAS COLLEGE OF MEDICINE is one of Top Medical College in Philippines in Cebu city. International students have the oppertunity to study medicine in phillipines at affordable cost and world class University. The college has successful alumni who have achieved well in the fields of law, business, politics, academe, medicine, sports and other endeavors. At University of the Visayas, we prepare students for a global competition.

    Direct MBBS Admissions Open: 2020-21
    Mobile No: +91 90329 55688
    Apply Now:

  5. MBBS in Philippines Wisdom Overseas is authorized India's Exclusive Partner of Southwestern University PHINMA, the Philippines established its strong trust in the minds of all the Indian medical aspirants and their parents. Under the excellent leadership of the founder Director Mr. Thummala Ravikanth, Wisdom meritoriously won the hearts of thousands of future doctors and was praised as the “Top Medical Career Growth Specialists" among Overseas Medical Education Consultants in India.

    Why Southwestern University Philippines
    5 years of total Duration
    3D simulator technological teaching
    Experienced and Expert Doctors as faculty
    More than 40% of the US returned Doctors
    SWU training Hospital within the campus
    More than 6000 bedded capacity for Internship
    Final year (4th year of MD) compulsory Internship approved by MCI (No need to do an internship in India)
    Vital service centers and commercial spaces
    Own Hostel accommodations for local and foreign students
    Safe, Secure, and lavish environment for vibrant student experience
    All sports grounds including Cricket, Volleyball, and others available for students


Popular Posts