“ Introduction Shock is clinical syndrome that results from poor tissue perfusion Poor tissue perfusion ↓ Body do not receive enough oxygen and nutrients to allow cells to function ↓ ↓ Cellular death Organ failure ↓ Whole body failure ↓ Death Feature Hypovolemic Shock Cardiogenic Shock Septic (Toxaemic) Shock Introduction – Most common form of shock.– Occurs due to decreased blood volume. – Caused by inadequate pumping action of heart. – Occurs due to severe bacterial infections or septicaemia. Causes 1. Acute haemorrhage2. Dehydration from vomiting, diarrhoea3. Burns4. Excessive use of diuretics5. Acute pancreatitis 1. Deficient emptying:a) Myocardial infarctionb) Cardiomyopathiesc) Rupture of the heart, ventricle or papillary muscled) Cardiac arrhythmias2. Deficient filling:a) Cardiac tamponade from haemopericardium3. Obstruction to the outflow:a) Pulmonary embolismb) Ball valve thrombusc) Tension pneumothoraxd) Dissecting aortic aneurysm 1. Gram-negative septicaemia (endotoxic shock):E. coli, Proteus, Klebsiella, Pseudomonas and Bacteroides.2. Gram-positive septicaemia (exotoxic shock):Streptococci, pneumococci. Pathogenesis ↓ Effective circulating blood volume → ↓ Venous return to heart → ↓ Cardiac output → ↓ Blood flow → ↓ Supply of oxygen → Anoxia → Inflammatory mediators → Acute circulatory failure (shock). Cardiogenic shock occurs when >40% of left ventricle is destroyed, leading to acute circulatory failure and tissue hypoperfusion. Gram-negative bacteria: LPS → binds CD14 → macrophage stimulation.Gram-positive bacteria: Lipoteichoic acid → binds TLR-2 → macrophage stimulation.Macrophages release TNF-α and IL-1 → vasodilatation + increased vascular permeability → inadequate tissue perfusion → septic shock. Symptoms 1. Increased heart rate (tachycardia)2. Low blood pressure (hypotension)3. Low urinary output (oliguria to anuria)4. Alteration in mental state (agitated → confused → lethargic) 1. Decreased tissue perfusion (tissue hypoxia) – Forward failure2. Pulmonary oedema – Backward failure Early stage: Tachycardia, warm extremities due to vasodilatation (hyperdynamic circulation).Late stage: Increased vascular permeability, decreased output and oliguria (renal failure). Stages Stage I (Mild hypovolemia): <20% volume loss. Only mild tachycardia with normal BP.Stage II (Moderate hypovolemia): 20–40% volume loss. Tachycardia with normal BP in supine position but hypotension in erect posture.Stage III (Severe hypovolemia): ≥40% volume loss. Classical signs of shock appear (tachycardia, hypotension, disorientation, etc.). No specific stages mentioned. 1. Early hyperdynamic stage2. Late hypodynamic stage Morphological Changes in Shock Organ Morphological Changes Brain Ischemic encephalopathy Kidneys Acute tubular necrosis, oliguria and electrolyte disturbances Heart Coagulative necrosis Liver Fatty change with hemorrhagic central necrosis Adrenal glands Cortical cell lipid depletion GIT Hemorrhagic enteropathy Lungs Uncommonly affected, but may show diffuse alveolar damage (shock lung)” Make html based illustrated mind map infographics as per the given text, nothing from given text must be changed and nothing must be added extra, and nothing must be skipped.