Definition and Pathophysiology of Shock

Shock is a syndrome of perfusion and cell oxygenation disruptions thoroughly so that tissue metabolic needs are not met. With the disruption of oxygenation results in impaired function of cells or tissues or organs, such as disturbances of consciousness, respiratory function, digestive system, urinary and circulatory system itself. In response to the decrease in oxygen supply, energy metabolism of cells will turn into anaerobic metabolism.

This situation can only be tolerated for a while, and if it continues, the damage of vital organ tissue happens that can lead to death. Shock is not a disease and not always accompanied by the failure of tissue perfusion. Shock can occur at any time to anyone. The handling is based on early right diagnosis.

Pathophysiology of shock

General:

Hypoperfusion in shock leads to the disruption of oxygen supply to cells, resulting in impaired cell metabolism and consequently the formation of ATP is reduced. Hypoperfusion also triggers reflex of sympathetic system activation that increases cardiac output. In addition, there is expenditure of ketokolamin, angiotensin, vasopressin and endothelia which will increase vascular tone so that perfusion pressure can be maintained and enough.

Hypoxia makes the tissue trying to extract O2 as much as possible so that the metabolic needs are met. When all the defense reflexes to the limit of tolerance and hypoxia are not resolved, it will disturb mitochondria, and decrease ATP formation. All systems in the body are not functioning, resulting in complete organ failure, such as brain failure, heart failure, vasoplegia, the buildup of lactic acid, kidney failure, digestive system failure followed by germ and toxic materials transfer into the bloodstream (translocation), and ending with death. Multiple organ failures and death are proportional to the duration and severity of hypoxia.

Specific:

Shock is divided into four types; hypovolemic, obstructive, cardiogenic, and distributive.

According to the value of cardiac output, shock is divided into two; hypodynamic and hyperdynamic shocks. In hypodynamic shock, cardiac output is below normal and central venous pressure is more than normal. Hypovolemic, cardiogenic, and obstructive shocks are included in this type of shock. In hyperdynamic shock, cardiac output value is more than the normal and central venous pressure is less than normal, e.g distributive shock.

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