2. • Profound hemodynamic
and metabolic disturbance
characterized by failure of
the circulatory system to
maintain adequate
perfusion of vital organs

3. Hypovolemic shock1
Septic shock2
Cardiogenic shock3
Anaphylatic shock4
Neurogenic shock5

5. • Reduced circulating blood volume
with secondary decreased cardiac
output
– Acute hemorrhage
– Vomiting/Diarrhoea
– Dehydration
– Burns
– Peritonitis/Pancreatitis

6. • Correct bleeding abnormality
• Aggressive Fluid replacement
with 2 large bore IV’s or
central line
• vasopressors are last line,
but commonly required.

8. • Due to bacterial infection – release of
bacterial toxins
• G(-/+ ) septicemia, pneumonia,
• peritonitis,
• meningitis,
• cholangitis,
• pyelonephritis,
• necrotic tissue, pancreatitis,
• wet gangrene,
• toxic shock syndrome, etc.

9. • Antibiotics
Semisynthetic Penicillin
with β-lactamase inhibitor
with an aminoglycoside
and vancomycin
• Imipenem-cilastatin
• Antifungal in immunocompromised

10. • Vasopressors
– Noradrenaline
• Excellent first choice
• Start 0.5-1 µg/min and titrate to response
– Dopamine
• Most common first line agent
– Dobutamine
• Start 5 µg/kg/min
• Hypotension unresponsive to Intravenous
fluids.

12. • Myocardial Injury or Obstruction to
Flow
– Arrythymias
– valvular lesions
– Acute MI
– Severe Congestive Heart Failure
– Ventricular Septal Defect
– Hypertrophic Cardiomyopathy
– Pulmonary Embolism

13. • Ventilatory support
– Often needed in pulmonary edema or
respiratory failure
• Ionotropics/vasopressors
– Dobutamine and Milrinone are agents
of choice

14. • Intraaortic balloon pump
– When all pharmacologic
therapy is failing
– Requires appropriate facility
and ICU/CCU
– Improves cardiac output by
30%

16. • Is a type 1 hypersensitivity causing
release of histamine leading to
1. Disruption of the microvascular
endothelium
2. Cutaneous arteriolar dilation and
pooling of blood in cutaneous venules
and small veins

17. • Epinephrine
– 1 cc of 1:10,000 IV infused slowly
and watch response
– 5 mg in 500 cc NS at 10 cc/hr
• Corticosteroids
– Decrease immune response
– Methylprednisolone 125mg IV
– Hydrocortisone 5-10 mg/kg IV

18. • Antihistamines
– Diphenhydramine 0.5 mg/kg IV
– Cimetidine 2-5 mg/kg IV
– Famotidine
• Intubation if needed

20. Loss of autonomic innervation of the
cardiovascular system (arterioles, venules,
small veins, including the heart)
• Causes:
1. Spinal cord injury
2. Regional anesthesia
3. Drugs
4. Neurological disorders

21. • Atropine
– First line therapy
• Volume expansion
• Vasopressors
– Ephedrine
• 10 mg IV bolus good for 3-4 hours
– Phenylephrine
• 100-180 µg/min IV until stable