The underlying process in the development of multisystem dysfunction in shock is decreased organ perfusion and oxygenation. The initial insult may be multisystem or may be organ specific, but both have the potential to lead to the multiple organ dysfunction syndrome if not diagnosed and treated adequately. The fundamental principle of management is the early restoration of organ perfusion and oxygenation with concurrent treatment of the initial insult. Without diagnosing and then treating the cause of the patient's illness, the outcome of supportive therapies is likely to be poor as the underlying disease process will not be halted and may progress, thus increasing the likelihood of multiple organ failure. For example, 72 h after bowel surgery a patient may show obvious signs of shock, with hypotension and tachycardia and the signs of the systemic inflammatory response syndrome (SIRS), the causes of which may be a chest infection with sepsis, anastomotic breakdown with peritonitis, or a myocardial infarction. Hence the correct diagnosis of the underlying disease process and treatment to halt this is as crucial as the restoration of global perfusion and oxygenation.
Classically, shock has been divided into the four distinct categories: hypovolemic, cardiogenic, septic, and neurogenic. In each of these categories there is a decrease or maldistribution of oxygenated blood supplying the tissues. Tissue oxygen delivery ( Do2) is made up of many components and is calculated using the equation
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