Hemorrhagic shock
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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.
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