GHOCIC Shock ts a (fe -dhrecdoning Clintced gyndorvu ok caviciovartette rattapie chanackenised by -an ceecle xeclucion of @Plecirve evscenteel ing blood volume Chypoteruion): and - Pr nackte perfusion af colt and simae Chy popen Paxton) ~"Frow (On gerondone shock rsa eratalatorxwy Imbatance blew oxnyycr Sypply and oxnyge peegriae oer of dhe cettulan tevel, and #s altro cattol cfacealouoney Ghoele. ~ Onitrod (on primary’) ghoclt” rs wucl fos qnamuron! ano wuclly 4 benign youovagal attaele sor ulting Prom euclaen pudU 10) ot wondur satan 70 7M huant cocd Py Newlogen'e yenodi(atas ron and on $0ynud peripheral pooling ot blood. . Cuintealty , paren of preirnout ghocl* Satan Prom drt odlacle posting fox Feew seesncls on minuto and oltve lop brirof cnton Crow rey, wooaknar , groking gomalron , p inne » weet k Grd xaprd paue, and (dc poo! preu cu a anal ClammyOtaurfreathon ano &tyo fog y » Hype volaemic whoclt This foam ‘oh Bhocle susalh PHOM /nads gud center (Ofony blood volumu hyd Vantow e@Hologic for faclonra hal. mey ba ethan Prom dhy lor of sed colt mau and Pleuma oun 49 haemoanhage , On Prom dh (ou of plaama voluru alone. a) Condtogente Shock: Acute crreutodony failu with euddon Fall rn conciac owpul Prom acute oluLou of dh Atcnt eotthow geucl reoludton af blood votumu swath nN conotrag enc Sheer. 3) Septic (Fo xae mic) Bhocle Govern baclenid rofecttont on gptr'caemen podace Bptie ,enodt- 91 may be seul! of Yxam- negadrnue &plreaemra (enclolow'e Shock’) gore PS Mox tommed, on ler afko Prom: bixam “pow hive @pi'co ern'a - 4) Anaphgylatre ehock Dur Jo Gove all engr'e an! tg @0 anlibedy suaction 10 Gahstiab fuch a dug , bleach produch , prueck Ou aarmal venam rs CotLed ane phglach'e Shock -5) Nlewwragenre ghoel OH fs coc Sy dhe fou of Symposbely tontiol of wewrsfane youck sudaltring 10 maw Aeted!o0 oF orton ol ancl venale Ao reothee! comel by gplood ancr dherta, Spinal concl Pofery pon che 8) odba Typer ) Praamalre. Ghock Bhoele vtweuling from JHauma ps ro iially dun to A pow ald enia , bat ewn ation hae. monathage haa been toplxolt ad thor pation tontinus» to Buhler tor of Plaama volumy into dhe tnieaiter of fojand tne i) Hepoasltenal Choelt H occur Pom unknown acbten al maa fliceney #2 which dre pabrenl furl do xuponel Moreoatty 70 dhe Shure Of Praumea, Sungeny OF Uline Padhoge nes In gennal atl foxnw of @hoclke /nvelw Follousing derangenus :)suclewod etfechw efarculaling plooel vol ‘i) Recleteed geypply OF onyyrr 40 ahs roll and frac wrrch swat anonta Ai)dn floromasony meoliclon anol sourn geeloauc Prom hoek procleiccd cell rnyiouy. ‘Padbogeneu's ol lg povola mle Ghoelr Ploama tou det 10 bw , olhyohasyon , ducumasre @ehoclr du Jo bload lou anol mayor Foter anager Dewsgecl rnsfravercean volun y Devrrgool Venow sadonn vr Derrured yeninreeon fill'ag vp Decrucud Gaol volunu y Domucud cardiac oulpal y Grads qual tu poration. - Blood hava Uff Arr body, Casing a dletsuseos aml ef vol of bleod veuck , yenow 21 4uun auton clue fo laut ol fluid ef 1D thu youre. on Spa:Sgroptoru —. “Pachy cordial Ugpotenator) “Olryentrer 10 aousiey _alleralron fo nudtal Slab Padhogeneur of condrogen'c Ghoelt ~ tar drogen vhock nauk Prom % eevenr efundion Prore cocekeeloy foP} ventnrcelor oly condi ot vowtour com Guth Or are my rnfosrcrg'On - Ionpairred pam ping abriidy af (0P} vonditek | ry J ' Derneaud SV Shackajvotl Soptolr ermpiying v f Elevated leP! vortnicalor frcling Derrcaud cordate pitouc ou) pul v L Sronrrecurd pulmonaay venoa pew Donvaud 8? ve b Inowaud pulmonusy capillouy NTA Dorrrouud tru prrfurion vy Plata : Eolyma ln tuny rn jordin Wy Ghocle -Syroplonm ~ Inleak pale Fachycondra, - Casecd ng -fhonineu of drucde - lon dof lonsclousnea Podhophystoleg gy ot sepie ehocle Sepire Hock suuld Prom gram - rayosiw badlenta entering gh body from genr Jo wo'nory pro , alimentouy tued , supHoboay duet on Skin . Foveu &ysson< irPlam masony seuporux 70 ro Petion ar Folloux: ) Achrvertron of macxophage - monocy ses . Lyges of gxuam rage ta badonta stele | endolonin , a (ypopolgso cchow "cu Ceps), roto etsculaton why 1) binds to (po polysacchanich - bradi'ag prolatn (LBP) -Ths torepo% of LRS-LEP binds 16 colt rootetul on tre Gurias of dhs mora cy / mma cnopnay which amu Grmalaled jo ela. book proroflammasory cyloKinw , ot moi? ip cu anf -& and IL-3The efled of dheu cy foktoe au cu andy a) By aon ing ondlodhe (rou coll adhurvencu . Nlavlvoph' A ewhich (bende Pree raeeal dhal corer vouculon fafoay APromotng ner ic onicle dyn drew ?. Phir Stimuloter inonuaud eye Spades of nifere Orel which fs qwaporatau Porr Vauo- ol} (ad asron and pypojorsio? ° Pm) Achivalion of odhon snflammasoxy gupon. a) Adruatton of ramplerury padbway End - prodack &§ C5 and C3q induce mictoem belr ancl enodsdhelras clamace 5) Nettucdton of mat coll - Clucdoméne rs pesleeucl sohich rormocus Coipitlong penmeabrd'dg c) Activalion of krnin Sydem - Relecurd dbya- dykinin, Coeur aroailation anel rpc pon meobr lity d) Aeb'vet io” of toagalodion Syslem . Enbove auveloprurd él dom bi flo) uswlt ot cobove rvethonu ng "S$ ucud- arted'00 and hacen vercular perrces tes lidg po Sophie shock -~ Ineracurd! aera ceclan poninocabrlrdey Cacata alevetoprurd of fof la roma sony ocuma . - Faclutedl blood! Plow procure Ayperoruen, snocle gual — pertouoa al ell ane) 14% , finally luoeling 0 ongan oly fondo: Sym Plomx -Reclutac Condnarch tity of dhe heund - fown arnt of wii - Blush clieloaayon ot (ips Dizzeneu - Mented confeurioa Podhogeneua ot Necwrogen'e shock — hott of &ympadhedre fons Mars'va vero (ed 0 | — vy Vonow dr'feliog , | . Dotenroi dlitedion Ww ! wy Venous petouin v J) W, phen iphenad qanulay Ve Oftola Volum sumweana. Ny hk lan cliace oulpud sh | Fas pentusionSymploma “_—. 5 Cycinou's D Chad porn DDN reel ty Boacdhing > Fern) pulu 2 (ypodhenmia Podhe genes ot Pro phy tod" ¢ Shocle TT Eaporvesu Jo ontigan \ Aetivalion of Gorritixed aolrbodi ey vy Potegen erbonttody xecwel 109 vb Nealereod Ri lcon of Veroaelrve | Wo dicvo rw SO i J Meuai've . (apillany pumoabiidg yvarool! (ed/on vb Sntouts'dtal ack ee Vero ancl anteacl , oli lalad 109Symplon ; Di ficcalty bruadhing - Swelling anda dhs akin ~ lowd BP - Blur dki'n Prom poor cistulodinn - Glin neuhe. - Youre Sualling Gloger of @hodle (Phock hax been diurebd tolo 3 Aoger D) corn poruce of (non + HOG LeU Le pinta , yuvensr ba) Ghocle 3) Progressive deco mpervaled hocly D Inxevertbs deorpersaled ghocls » ‘rompermased (noo. prog rourye _rorirad proverb shod) Qo dhe eonty Cage of Shoclt, an atlem ps & mach #0 mou'nton adquole rou bral and radonony bloocl supply hg > Oat bublon of blood & dhal dw vital ougeurs (bx ron andl nant) ou ad uelely porrued and OGRE ey ghia 1s achteved by du ack'vatrioy ot vantoun reeanhorrorad rruchanisey causing goto gprad vasoton tered on owned by Plural conservaly, ry den long“OP Ahy pondtron dhe fered dha whork 1's dolrg ita fotey Nucded chi componatory ms Chanuty may be abl fy bring Ohaus ysioveng and el chucdedon Shi ty sre vor FU shor: . te-etobtuh drt nosm utlecl core ponscilocl ah Ahr mmiponalong mechanism ax oF Arde Dd ulidespred — yaacantnrcdion I serpor lo vectucal blood Plow (reypotensren) and fuses anoxia, ght newal and Ahumoot Rehys (Eg:- brvro neve pion, chamosteceplons), au adraate el dwing ahoul euod can pilon - talidogpruad vasotontnictron 13 & pwofoe/rue machan'sm at rh cocus yorruaud port phone | eros fonuaud hicul stale ond yoouaud plocal prev cu ) Ylard consearedron by dri laeelooy » 9n ender Jo componsot dhi adual Jor of blood volun fn Ny povoleennre ehocle, chu Eillonng Botkorn mtd ats). 70 oeerlon'ngy dhi btoaed vol and Argo wow wonour sedorar Ja Jr hood. AYReteau oF aldostorons Bron hypowre Ache by adrudron of wwn'n ang olenaia - otdostonora nucharum - 5) Rulecun of Aor dew 6 od eflodrus titi Cwi'ng blood woluneO)'Pe4 ered! glorncaulon Ptsiation Hob (Grr K - J er 40 avtlonrafan fonlerclran ) A) whrPling do foren Plutel into dha pleura au fy tocwowd aapilteay hg oaostat @ pPturcut (hype ono 0), fi) Shimmalarion o! acbu rod mudella Sp sepona Jo focoen rorarac ow pat, achurs/ midalta ,7S Crmulalid fo vebru af exceu of atecholamrns Cepiruprsary and 700 » oprocp pyr) cohich “noua Aroat nats sand Ing 7a FA conchae Ded put Priogpeniat decom paruod oof Ghochy Thue ts a stage whin dh paren gate kro Gorm otha Gor on nuke Patloru bed porrstenres OF de eho tonclr#/o0 5 dhis faa progren'w ole forvaas ron . gr eho at susulfant Fturus hypo peseuton hock cu a 1p pregirourn clecomperacued andlor Pulmonary hypo potion Derormpervaleel hoch coosrens pulmonouy porfouron and rntrecu veurulan pearaahs ls 4gPr) lachypnooc and ancttttt seespractloncy Aes hin agnor (ARP s) P)9rssaa ysehaemta Imparred Ju cu perfusron coed Sor Ich to anacnohre glglolysn He OI ey Ptom aerobic . hace acoder min vata bolrc tachre qerdeous aoareb 10 doin malar my roothod tvs Thi seul! at blood. foto fit youu Pl drt aoMmoo nt JUPo in ouodlteian and poniprancd pool'ny bran colly at ahis ehage Gh patent clevelo pr tondurron and ceoxsen’ng ot ounal fenctron I xeventbu decoraporaleol shock aera eee fallin dtu Shock es 80 Sevou ghat rv spre of tom peracd Oey muchanum ancl dorprte dhenapy anol control o/ earologr thi Ghock , M0 per toveny quecomporatel on Houvenbe sheclt OF ePMack dur Jo cwrels sprucal roll Papua au ov Follour- agenk wonrch ranud Jal place, 77 & called 7) Drogrwive varodtatal a7 Dunriny har tourer Hage of shocls, ane Ka damagu “dhe cuprteay ard venetlan collrohrlr arefanrorer Actor ynneporartas fo Veug oniniddona and hegre do drtate ~Youodriatron sualh yn phurphal poe ting of blood eohiich Pur thn deo, fertorata dh Ce Hochiy Chace ld ng hloocl volo. i) Inne crcl ajar cetera * porrvabt tidy Poul dlamage Jo Hut se toa pxo/n- Flam meony rmaclretor cohi'th foereer sarod Vourelon peamuabiu'dy Th sw 20 ACaPe af fluted Prom errculotfon yolo ons roses Ital cen eu ol NY Imus ghur duinroscing effockiu blood volun i) Myocanclicd dspruuan! favlon (rie) Progueulus fall rn dhe blood pres and sucured plood flow to mgocorei'um (Uke COLONOAY mngutieronty and myoro aval eyehainig gle fo pealearr pf myoconreliel! olupreuron Fach (rn0F) Fru sul rn Fardha alap rcearon- ot Candrac gundron, xeclused ranatae ovlpud and drowned blood Plowiv) toon tng palmonany hy popes “euro Yudhen pulmencay hy poportiuron PAA Seaphicloay duirou olut do pulang ccma , Jachgpnoea andl RMS mpwrolog arson Syncliouy CARDS) v) Anowa damage Jo hunk , hidneg and brain Prtogprevs vet Jude anonicr cucu mufarboire autlou's aut fo anaerobic gig yer Cow Thu ts xelecu of puorhfle mma Yong eyfoltvel and adber rotlommotong prdraloa ond Gen alron of Pru xercliele. ~Gnie high le pe cralrsod roll of dha myarr Jobalon cols of frdney nar nis ewe Clipon cunt on oenrohrc / tion, dno %s eschacra'c drum , proximal newons of dhe ¢ ol pr aca fon PIP gerne coll dtadh 10 ghor AUC vi) Hyper toagutetytriy of blooel Fl Ti'yus darmowe 0 ahocls aclrunler foage l- tron taescocls wwordh HLleaw of Clof promoriny Fathy, ahaom hoplas tin and ute of plulets aggreyalon, IPP which tontuthuler Jo eleuiiny of plood~ sua and varculer puombote Gn thir wee ngperroagalahrtrdy oF blood aordh Comma urn muroredhromhi ropara dhe blood Plow and cut furihir grQur mtinoiCliniectty , at Jhu Stays dh pollard ha, Hocus of roma, coowrroned fuol Pandeoy, and prog xreunus sunel failou aw fo ae fobular nervous Chintcel Reluru ancl rornplrcations ~~ The claurceel Poole of decom povod Shoctr Mu ‘) ery fow blood preuwy 8) dubnoam al Tomp 3) feeb. ancl tanegulan pulu 4) shallows and org fuing stu pr'éad a7 4, additton , dht palfard an &hoels how pols fou, euolan cyer, woaknou , cold and ela romy Shin a hfe - dhotecdening comple vont rn shocle cou dur fo Ngponic roll rofemy yeuralling 7” rmm uno- roflammatony stupor and aelvetlion ot vorrour cou cadclu (Clobing , (ompumurs , /tnin) Phir nctuckt , 1) Acule stoaptacslony dlrshieu gyndnann 3) Dixem roalecl rotiavarcaloa tou gerleurgr 3) Acuk suncl fullau A) Matipt argon dystun ton by poemManagment ol Ghoel General principla of ehock Mong runs 2 Ae overall geal of shock Managener! 15 40 rmpxove oxygen ale liven ) wdi' xed fon in orclen #0 Pruven) rellulorn anal ongern Prfury « aogier prsad nue of circle. 2) Phechive dberopy (g tng etfologg - 3) Restoration of aclig uch porhuuion ,montloainy ancl comprrhentive eupportrr rou. 4) Interventions Jo rustora perfuu'oo ronhu, borsaauiny Conder ocdput and opirmis!'ng onggen toniant Bony ger cuumand should ato 6° suclacec!Manaymend ol ely povoluemie ghock « Manimstre omtygen dlelirvony - roroplilod by enrening aclyuacty of qyoni lation -lonktol Farther bloocl tov - Yur seaactation Manag mans of Goptre Bhork The mos) hpontant arpeck of dherapy Fon porionk wrdh saptre Shoelt | Sepsis rnc tuck D Adsqerod oxyyen clilresny ) Cnystallora Plural adminislacd'on - norma) Guin (ory. Nlacl) , Ringer tadack 3) Brood Spetnury ardibigin - tefoloms ny Chirclancgei cofinianon, Cipnoflouau'o, mettonrclorol cofkeprnu levoflowacin, Vaneomyaln . 4) Alpha ancl bela oly oobi ener agonu) 7 Nor -eprnephsins, alopo mune , do bale mins ; epinephaiay VongpH eur , adc: SD lonbioslentoks (la, hyobioroatisons , dit anedhauons.Nanagnunt oF Necviogente Shock Spnpoobitizal ion : OF dhe pahiont how @ genpocloe cute Of Spinal cond nfony Chigh dou Glnord fo reduce foflanamesio - iv Flack + ad mind ron of pu Flards °S dong fo Sabie di patient's dblooc) preva = Snotnop'c agents cue on dopararra may be mead for Flurd Herwsertodi'on ~ Aaopire rs given sora verourty Jo manay SQV bpraaly cou Ara Manager of Cancliogen shoele J Suppon tre mun tncluods D Onyyen dh nary ~ Fudrorour un of Pluicl wreh couful monitorng Of temirta) Venous proud OM pulmen ouiy ~weelox pstrnunu ~ Other monitoning rnetuck sont'nocs £t6r, 12 leg Ele, wnt op, Ud ancl etettoly fer ancl blood ga: ~poliont should he pon pre forably menag ed 19 tononony cmt unl:- Druga la monrphin s-lomg IV pulp to stelierg pam ancl an miodg euoeredee) word my - Ono mopre cruppon i Keeppontk MIG bo nude nrcoal voodoo ancl nuchoa Manaerun af fnaphg lore ehoclt Dunng an anaphy (ore anoek , aan Clit al no rong sercedcrd ab ron Cee) mey he nucle pf baceedhinc fx heowt beet 7S ohyppecl MM ccli'calrors snerecl )E pingp buns (ochunali'nt) Jo strclu ee body's leng rg tA porw . 3) ony gen , which hols 0 brua dhing 7 3) Iola venous anirhe farares and ton}uora Jo quota rnflammat/oa of QA paurdg. and Hrapous braadhiag 4) Bola agoriu ape (eg fs Pa lerol) JO nrecleree sto trove braadh ng symplo ms -