Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Critical Care Medicine

Shock is one of the most complex conditions encountered in the critically ill patients , the underlying cause can be evident as in hemorrhagic shock or occult as in sever sepsis due to infection1 . Delayed shock resuscitation is associated with significant morbidity and mortality and therapy should be initiated even before all clinical information and diagnostic studies are available , although the mortality remains high, the increasing application of early goal-directed therapy ( EGDT ) to achieve defined physiologic endpoints has significantly improved patient outcome ( ¹,²,³ ). Alfred Blalock (⁴) found that the hypotensive state and high mortality rate of shock were reversible by crystalloid infusion to replace lost intravascular and interstitial fluid and that simple reinfusion of lost blood was not sufficient , So shock was identified as systemic disorder caused by increased the vascular permeability , interstitial edema and intravascular volume depletion with the classic sign of hypotension , decreased urinary output and multiple organ failure.The challenges to the intensivist are to identify the hypoperfused state , diagnosing its cause and rapidly restoring the cellular perfusion. Shubin and Weil{u2019}s (⁵) classic paper distinguished the various forms of shock with respect to cardiovascular parameters : Hypovolemic ( such as dehydration , diarrhea and hemorrhage , the most common form of shock following major trauma ) .Distributive shock ( such a septic shock , the most common cause of shock in late recovery phase or after major surgery or major trauma ).Cardiogenic ( such as from massive myocardial infarction , arrhythmia ) . Obstructive (such as tension pneumothorax , pulmonary embolus , or pericardial tamponade )

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