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Harrison's Principles of Internal Medicine, 18e
| Part 12. Critical Care Medicine > Section 2. Shock and Cardiac Arrest > |
Chapter 270. Approach to the Patient with Shock
Sections: Approach to the Patient with Shock: Introduction, Pathogenesis and Organ Response, Specific Forms of Shock, Adjunctive Therapies, Further Readings.
Topics Discussed: shock.
Excerpt:"Shock is the clinical syndrome that results from inadequate tissue perfusion. Irrespective of cause, the hypoperfusion-induced imbalance between the delivery of and requirements for oxygen and substrate leads to cellular dysfunction. The cellular injury created by the inadequate delivery of oxygen and substrates also induces the production and release of damage-associated molecular patterns (DAMPs or "danger signals") and inflammatory mediators that further compromise perfusion through functional and structural changes within the microvasculature. This leads to a vicious cycle in which impaired perfusion is responsible for cellular injury that causes maldistribution of blood flow, further compromising cellular perfusion; the latter ultimately causes multiple organ failure (MOF) and, if the process is not interrupted, leads to death. The clinical manifestations of shock are also the result, in part, of autonomic neuroendocrine responses to hypoperfusion as well as the breakdown in organ function induced by severe cellular dysfunction (Fig. 270-1)...."
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