Preface

Shock is a clinico-pathologic state characterized by a mismatch between oxygen demand and oxygen delivery leading to tissue hypoxia and impairment of physiological functions. If the underlying precipitating factors are not identified, then the initial compensatory phase can be followed by a cascade of neuroendocrine compensatory mechanisms leading to decompensation and irreversible damage to organs and increased morbidity and mortality. Comprehensive management of a shock patient requires early diagnosis, identification of the underlying pathology, and a comprehensive goal-oriented management protocol. If left untreated or undetected, shock can result in life-threatening complications and negative outcomes. Hence, early detection should be the goal of physicians involved in the management of cases with potential shock of any etiology. Shock can be categorized as septic shock, anaphylactic shock, cardiogenic shock, hypovolemic shock, and neurogenic shock. The broader objective should focus on early detection of shock to identify the underlying etiology and the type of shock, as well as determine management strategies. This book enhances understanding of shock, including its pathophysiological and clinical characteristics, and can help health practitioners to identify shock and develop effective management approaches.

> **Amit Agrawal** Professor, Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India

### **Vaishali Waindeskar**

Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, Bhopal, India

**1**

**Chapter 1**

*and Amit Agrawal*

of this subgroup of patients.

**2. Clinical examination**

**1. Introduction**

Introductory Chapter: Concomitant

*Vaishali Waindeskar, Ved Prakash Maurya, Rakesh Mishra* 

Younger people in developing countries are more frequently affected by head injuries, which have substantial economic and social effects. In patients with traumatic brain injury (TBI), external or internal haemorrhages have the potential to cause systemic hypotension [1, 2]. They can be associated with poorer outcomes (increased morbidity and mortality) compared to patients with TBI alone [3, 4]. Even brief episodes of hypotension have been shown to cause both systemic and cerebral hypoperfusion and secondary brain injury [5]. This systemic hypertension can be further complicated by raised intracranial pressure (due to TBI-related lesions), which can further compound the treatment protocols [6]. In trauma patients, the occurrence of haemorrhagic shock is associated with high mortality (as high as 50%) [7], and the reported incidence ranges from 6-16% [8]. These cases need to be differentiated from those in the paediatric population, where the isolated TBI can lead to severe shock (in the absence of apparent haemorrhage) [9, 10]. Understanding the interaction of the simultaneous presence of TBI and haemorrhagic shock is essential to implement the optimal resuscitation strategy [11] and, thus, developing strategies to improve outcomes in this subgroup of patients [5]. Investigators have used animal models to define the optimal post-resuscitation mean arterial pressure levels to ensure organ perfusion and, thus, maintain good organ functions and survival patterns [2]. The present article discusses the concepts and controversies associated with concurrent TBI and haemorrhagic shock, the clinical approach, and the management

The clinical examination of a patient with suspected haemorrhagic shock and TBI is aimed at determining the source of the bleeding from any systemic external or internal injuries and understanding the severity of the head injury. The cursory examination of the neurological status involves the evaluation of the Glasgow Coma

Traumatic Brain Injury and

Haemorrhagic Shock

*Sri Rama Ananta Nagabhushanam Padala,* 
