Hemorrhagic shock

Shock

Inadequate tissue Perfusion

and Oxygenation

Hemorrhagic shock

The most common cause of shock in the

surgical or trauma patient is loss of

circulating volume from hemorrhage

Brunicardi FC, Anderson DK, Billiar TR, et al.. editors. Schwartz’s principles of surgery. 9th ed. NewYork: Mc Graw-Hill; 2009.

Guyton A C, Hall E J. Textbook of medical physiology. 11th ed. Philadelphia. Elsevier; 2006.

Normal blood volume

7% of body weight

Stage of hemorrhagic shock

In 70-kg

Brunicardi FC, Anderson DK, Billiar TR, et al.. editors. Schwartz’s principles of surgery. 9th ed. NewYork: Mc Graw-Hill; 2009.

Stage of hemorrhagic shock

Longo D D, Kasper L D, Jameson L J, Fauci S A, Hauser L S, Loscalzo J. Harrison’s

principles of internal medicine. 18th ed. NewYork: Mc Graw-Hill; 2012.

Pathogenesis

Cardiovascular

response

Cardiac output

Baroreceptor

VasoconstrictionHR

CVP EDV

Klabunde, RE, Cardiovascular Physiology Concepts, Lippincott Williams & Wilkins, 2004

SV

Frank-Starling

Mechanism

Arterial pressure

Contractility

Sympathetic

Pathogenesis

Neuroendocrine

response

Pathogenesis

Brunicardi FC, Anderson DK, Billiar TR, et al.. editors. Schwartz’s principles of surgery. 9th ed. NewYork: Mc Graw-Hill; 2009.

Baroreceptor

Chemoreceptor

Adrenergic output

α1, β1 receptor

Vasoconstriction

Adrenocorticotropic

hormone (ACTH)

Hypothalamus

Glycogenolysis

Gluconeogenesis

insulin

elevates blood

glucose

uptake of glucose

amino acids

Lipolysis

Gluconeogenesis

Glucagon

Microcirculation

Pathogenesis

Brunicardi FC, Anderson DK, Billiar TR, et al.. editors. Schwartz’s principles of surgery. 9th ed. NewYork: Mc Graw-Hill; 2009.

Muscle

Skin

Splanchnic circulation

Blood flow

Catecholamine

vascular resistance

Autoregulation of

the heart, brain & kidney

MAP ≤60 mmHg

blood flow

Pathogenesis

Capillary hydrostatic

pressure

Microcirculation

Capillary beds

perfusion

Intravascular oncotic

pressure constant

Starling’s law of capillary interstitial liquid exchange

Longo D D, Kasper L D, Jameson L J, Fauci S A, Hauser L S, Loscalzo J. Harrison’s principles of internal medicine. 18th ed. NewYork: Mc Graw-Hill; 2012.

Hormonal

response

Cellular response

Pathogenesis

Brunicardi FC, Anderson DK, Billiar TR, et al.. editors. Schwartz’s principles of surgery. 9th ed. NewYork: Mc Graw-Hill; 2009.

Oxidative

phosphorylation

Tissue poor perfusion

Anaerobic

metabolismATP

Hydrogen ions

Lactic acid

Metabolic

acidosis

Pathogenesis

Vicious cycle of shock

Brunicardi FC, Anderson DK, Billiar TR, et al.. editors. Schwartz’s principles of surgery. 9th ed. NewYork: Mc Graw-Hill; 2009.