Trauma Care – Shock Overview

CLASS DIAGRAM

classDiagram
    class Shock {
        +Definition: Acute circulatory failure
        +Manifestation: Cellular dysfunction
        +Life-threatening condition
        +evaluatePatient()
        +restoreTissuePerfusion()
    }
    
    class HypovolaemicShock {
        +Definition: Collapse of cardiac preload
        +Causes: Blood loss, Plasma loss, ECF loss
        +identifyCause()
        +controlBloodLoss()
        +replaceFluid()
    }
    
    class CardiogenicShock {
        +Definition: Pump failure
        +Causes: MI, Arrhythmias, Cardiomyopathies
        +improveContractility()
        +treatUnderlyingPathology()
    }
    
    class DistributiveShock {
        +Definition: Collapse of peripheral resistance
        +Mechanisms: Vasodilation, Peripheral pooling
        +restoreVascularTone()
    }
    
    class ObstructiveShock {
        +Definition: Physical restriction to blood outflow
        +Causes: PE, Tamponade, Tension pneumothorax
        +removeObstruction()
    }
    
    class EndocrineShock {
        +Mixed shock presentation
        +Causes: Hormonal imbalances
        +correctHormonalImbalance()
    }
    
    class SepticShock {
        +Bacterial endotoxins
        +Cytokine activation
        +Endothelial damage
        +administerAntibiotics()
        +controlInfectionSource()
    }
    
    class AnaphylacticShock {
        +Type 1 hypersensitivity
        +Histamine release
        +administerAdrenaline()
        +administerSteroids()
    }
    
    class NeurogenicShock {
        +Unopposed vagal tone
        +Spinal cord injury
        +secureAirway()
        +administerVasopressors()
    }
    
    class ClinicalFeatures {
        +General: Cold skin, Rapid pulse
        +Specific: Type-dependent
        +Severe: Oliguria, CNS disturbances
        +assessSeverity()
    }
    
    class Management {
        +General: O2, IV access, Monitor
        +Specific: Type-dependent
        +Complications: DIC, MODS
        +provideSupportiveCare()
        +preventComplications()
    }

    Shock <|-- HypovolaemicShock
    Shock <|-- CardiogenicShock
    Shock <|-- DistributiveShock
    Shock <|-- ObstructiveShock
    Shock <|-- EndocrineShock
    
    DistributiveShock <|-- SepticShock
    DistributiveShock <|-- AnaphylacticShock
    DistributiveShock <|-- NeurogenicShock
    
    Shock --> ClinicalFeatures
    Shock --> Management

FLOW CHART

flowchart LR
    %% Main Shock Overview
    SHOCK[SHOCK\nAcute circulatory failure compromising tissue perfusion] --> INTRODUCTION
    SHOCK --> TYPES
    SHOCK --> CLINICAL
    SHOCK --> INVESTIGATIONS
    SHOCK --> MANAGEMENT

    %% Introduction Section
    INTRODUCTION[Introduction] --> DEF[Definition: Acute circulatory failure\ncompromising tissue perfusion]
    INTRODUCTION --> MANIFEST[Manifestation of cellular\ndysfunction due to inadequate perfusion]
    INTRODUCTION --> THREAT[Life-threatening: progresses to\nirreversible damage if untreated]

    %% Types of Shock Section
    TYPES[Types of Shock] --> HYPO[Hypovolaemic Shock]
    TYPES --> CARDIO[Cardiogenic Shock]
    TYPES --> DISTRIB[Distributive Shock]
    TYPES --> OBSTRUCT[Obstructive Shock]
    TYPES --> ENDO[Endocrine Shock]

    %% Hypovolaemic Shock
    HYPO --> HYPO_DEF[Definition: Collapse of cardiac\npreload due to reduced volume]
    HYPO --> HYPO_CAUSES[Causes]
    HYPO --> HYPO_PATH[Pathophysiology]

    HYPO_CAUSES --> BLOOD_LOSS[Blood Loss]
    BLOOD_LOSS --> INTERNAL[Internal hemorrhage]
    BLOOD_LOSS --> EXTERNAL[External hemorrhage]
    
    HYPO_CAUSES --> PLASMA_LOSS[Loss of Plasma]
    PLASMA_LOSS --> BURNS[Extensive burns]
    PLASMA_LOSS --> PERITONITIS[Peritonitis]
    
    HYPO_CAUSES --> ECF_LOSS[Loss of Extracellular Fluid]
    ECF_LOSS --> OBSTRUCTION[Intestinal obstruction]
    ECF_LOSS --> DIARRHEA[Diarrhea and vomiting]
    
    HYPO_CAUSES --> INTERSTITIAL[Massive fluid loss into\ninterstitial tissues]
    INTERSTITIAL --> SEPSIS_CAUSE[Sepsis]
    INTERSTITIAL --> PANCREATITIS[Acute pancreatitis]

    HYPO_PATH --> EARLY[Early Stage]
    EARLY --> REDUCED_VOL[Reduced circulating volume]
    EARLY --> BARO[Baroreceptor response]
    EARLY --> ADRENAL[Adrenal-sympathetic stimulation]
    EARLY --> CATECHOLAMINES[Adrenaline/Noradrenaline release]
    EARLY --> INCREASED_HR[Increased heart rate and vasoconstriction]
    
    HYPO_PATH --> MIDDLE[Middle Stage]
    MIDDLE --> OVERACTIVITY[Continued sympathetic overactivity]
    MIDDLE --> RAAS[Activation of RAAS]
    MIDDLE --> SPLANCHNIC[Splanchnic vasoconstriction]
    MIDDLE --> BACT_TRANS[Bacterial translocation]
    MIDDLE --> ANAEROBIC[Anaerobic respiration and lactic acidosis]
    
    HYPO_PATH --> LATE[Late Stage]
    LATE --> COMP_FAIL[Compensatory mechanisms fail]
    LATE --> ENDOTHELIUM[Capillary endothelium damage]
    LATE --> CEREBRAL_DEC[Decreased cerebral blood flow]
    LATE --> PROG_DYSF[Progressive cerebral dysfunction]

    %% Cardiogenic Shock
    CARDIO --> CARDIO_DEF[Definition: Pump failure;\nventricles fail to pump sufficiently]
    CARDIO --> CARDIO_CAUSES[Causes]
    
    CARDIO_CAUSES --> MI[Acute Myocardial Infarction]
    CARDIO_CAUSES --> ARRHYTHMIA[Arrhythmias]
    CARDIO_CAUSES --> CARDIOMYOPATHY[Cardiomyopathies]
    CARDIO_CAUSES --> VALVE[Heart valve problems]
    CARDIO_CAUSES --> MECHANICAL[Mechanical factors]

    %% Distributive Shock
    DISTRIB --> DISTRIB_DEF[Definition: Collapse of\nperipheral resistance]
    DISTRIB --> DISTRIB_MECH[Mechanisms]
    DISTRIB --> DISTRIB_TYPES[Subtypes]
    
    DISTRIB_MECH --> VASODIL[Vasodilation of arterioles & venules]
    DISTRIB_MECH --> POOLING[Peripheral pooling]
    
    DISTRIB_TYPES --> SEPTIC[Septic Shock]
    SEPTIC --> ENDOTOXINS[Bacterial endotoxins]
    SEPTIC --> CYTOKINES[Cytokine activation]
    SEPTIC --> ENDO_DAMAGE[Endothelial damage]
    
    DISTRIB_TYPES --> ANAPHYLACTIC[Anaphylactic Shock]
    ANAPHYLACTIC --> HYPERSENSITIVITY[Type 1 hypersensitivity reaction]
    ANAPHYLACTIC --> HISTAMINE[Histamine/vasoactive amine release]
    
    DISTRIB_TYPES --> NEUROGENIC[Neurogenic Shock]
    NEUROGENIC --> VAGAL[Unopposed vagal tone]
    NEUROGENIC --> SPINAL[Cervical spinal cord injury]

    %% Obstructive Shock
    OBSTRUCT --> OBSTRUCT_DEF[Definition: Physical restriction\nto blood outflow]
    OBSTRUCT --> OBSTRUCT_CAUSES[Causes]
    
    OBSTRUCT_CAUSES --> PE[Pulmonary embolism]
    OBSTRUCT_CAUSES --> TAMPONADE[Cardiac tamponade]
    OBSTRUCT_CAUSES --> PNEUMO[Tension pneumothorax]

    %% Endocrine Shock
    ENDO --> ENDO_DEF[Combination of hypovolaemic,\ncardiogenic, and distributive shock]
    ENDO --> ENDO_CAUSES[Causes: Hormonal imbalances]

    %% Clinical Features
    CLINICAL[Clinical Features] --> GEN_FEATURES[General Features]
    GEN_FEATURES --> COLD_SKIN[Cold, white, clammy patient]
    GEN_FEATURES --> RAPID_PULSE[Rapid thready pulse]
    GEN_FEATURES --> INC_RESP[Increased respiratory rate]
    
    CLINICAL --> BP_DROP[Fall in arterial BP]
    CLINICAL --> OLIGURIA[Reduced urinary output]
    
    CLINICAL --> SEPTIC_UNIQUE[Septic Shock contrast]
    SEPTIC_UNIQUE --> HOT_SKIN[Hot, flushed skin]
    SEPTIC_UNIQUE --> BOUNDING[Bounding pulse]
    
    CLINICAL --> SEVERE_SIGNS[Severe Signs]
    SEVERE_SIGNS --> WEAK_PULSE[Weak, thready pulse]
    SEVERE_SIGNS --> COLD_PERIPHERY[Cold, clammy skin]
    SEVERE_SIGNS --> COLLAPSED_VEINS[Collapsed peripheral veins]
    SEVERE_SIGNS --> TACHYPNEA[Rapid respiration]
    SEVERE_SIGNS --> CNS_DISTURB[CNS disturbances]
    SEVERE_SIGNS --> ANURIA[Oliguria or anuria]

    %% Investigations
    INVESTIGATIONS --> HB[Baseline hemoglobin/hematocrit]
    INVESTIGATIONS --> GROUP[Blood grouping and cross-matching]
    INVESTIGATIONS --> ELECTROLYTES[Serum electrolytes, urea, creatinine]
    INVESTIGATIONS --> ABG[Arterial blood gases]
    INVESTIGATIONS --> LACTATE[Serum lactate]
    INVESTIGATIONS --> GLUCOSE[Blood glucose]
    INVESTIGATIONS --> CULTURES[Blood cultures]

    %% Management
    MANAGEMENT[Management] --> AIM[Aim: Restore tissue perfusion and oxygenation]
    MANAGEMENT --> GEN_STEPS[General Steps]
    MANAGEMENT --> SPEC_TREAT[Specific Treatment]
    MANAGEMENT --> COMP[Complications]
    
    GEN_STEPS --> O2[Oxygen therapy]
    GEN_STEPS --> IV_ACCESS[Venous access and fluid resuscitation]
    GEN_STEPS --> MONITOR[Continuous assessment]
    GEN_STEPS --> PRIMARY[Treat primary problem]
    
    SPEC_TREAT --> TREAT_HYPO[Hypovolaemic Shock Treatment]
    TREAT_HYPO --> ID_CAUSE[Identify cause of fluid loss]
    TREAT_HYPO --> CONTROL_BLEED[Control blood loss]
    TREAT_HYPO --> FLUID_REPLACE[Fluid replacement]
    
    SPEC_TREAT --> TREAT_CARDIO[Cardiogenic Shock Treatment]
    TREAT_CARDIO --> FLUID_CAREFUL[Cautious fluid resuscitation]
    TREAT_CARDIO --> INOTROPES[Improve myocardial contractility]
    TREAT_CARDIO --> TREAT_UNDERLYING[Treat underlying pathology]
    
    SPEC_TREAT --> TREAT_ANAPH[Anaphylactic Shock Treatment]
    TREAT_ANAPH --> ADRENALINE[Adrenaline]
    TREAT_ANAPH --> STEROIDS[Hydrocortisone & Chlorpheniramine]  
    TREAT_ANAPH --> FLUID_IV[IV fluids]
    
    SPEC_TREAT --> TREAT_NEURO[Neurogenic Shock Treatment]
    TREAT_NEURO --> AIRWAY[Secure airway]
    TREAT_NEURO --> FLUID_NEURO[Fluid resuscitation]
    TREAT_NEURO --> PRESSORS[Vasoconstrictors if needed]
    
    SPEC_TREAT --> TREAT_SEPTIC[Septic Shock Treatment]
    TREAT_SEPTIC --> FLUID_SEPTIC[Adequate fluid resuscitation]
    TREAT_SEPTIC --> ANTIBIOTICS[Appropriate antibiotics]
    TREAT_SEPTIC --> SURGICAL[Surgical elimination of infection source]
    
    COMP --> DIC[Disseminated Intravascular Coagulation]
    COMP --> MODS[Multiple Organ Dysfunction Syndrome]

    %% Style classes
    classDef default fill:#f9f9f9,stroke:#333,stroke-width:1px;
    classDef main fill:#d4f1f9,stroke:#333,stroke-width:2px,font-weight:bold;
    classDef section fill:#e6f3ff,stroke:#333,stroke-width:1.5px,font-weight:bold;
    classDef subsection fill:#f0f7fb,stroke:#333,stroke-width:1px;
    
    %% Apply styles
    class SHOCK main;
    class INTRODUCTION,TYPES,CLINICAL,INVESTIGATIONS,MANAGEMENT section;
    class HYPO,CARDIO,DISTRIB,OBSTRUCT,ENDO,GEN_FEATURES,SEVERE_SIGNS,SEPTIC_UNIQUE,GEN_STEPS,SPEC_TREAT,COMP subsection;