What is shock?

Shock is a life-threatening medical condition whereby the body suffers from insufficient blood flow throughout the body. Shock often
accompanies severe injury or illness. Medical shock is a medical emergency and can lead to other conditions such as lack of oxygen in
the body's tissues (hypoxia), heart attack (cardiac arrest) or organ damage. It requires immediate treatment as symptoms can worsen
rapidly.

Medical shock is different than emotional, or psychological, shock that can occur following a traumatic or frightening emotional event.

What are the types of shock?

Septic shock results from bacteria multiplying in the blood and releasing toxins. Common causes of this are pneumonia, intra-
abdominal infections (such as a ruptured appendix) and meningitis.

Anaphylactic shock is a type of severe hypersensitivity or allergic reaction. Causes include allergy to insect stings, medicines or foods
(nuts, berries, seafood) etc.

Cardiogenic shock happens when the heart is damaged and unable to supply sufficient blood to the body. This can be the end result
of a heart attack or congestive heart failure.

Hypovolemic shock is caused by severe blood and fluid loss, such as from traumatic bodily injury, which makes the heart unable to
pump enough blood to the body.

Neurogenic shock is caused by spinal cord injury, usually as a result of a traumatic accident or injury.

What are the causes of shock?

There are several main causes of shock:

 Heart conditions (heart attack, heart failure)

 Heavy internal or external bleeding, such as from a serious injury

 Dehydration

 Infection

 Severe allergic reaction

 Spinal injuries

 Burns

 Persistent vomiting or diarrhea

What are the signs and symptoms of shock?

Low blood pressure is the key sign of shock.

Symptoms of all types of shock include:

 Rapid, shallow breathing

 Cold, clammy skin

 Rapid, weak pulse

 Dizziness or fainting

 Weakness
Glasgow Coma Scale

What is a "coma"?

Coma is a state of unconsciousness whereby a patient cannot react with the surrounding environment. The patient cannot be wakened
with outside physical or auditory stimulation. The inability to waken differentiates coma from sleep. Patients can have different levels of
unconsciousness and unresponsiveness depending upon how much or how little of the brain is functioning.

What is the Glasgow Coma Scale?

The Glasgow Coma Scale was developed to provide health-caregivers a simple way of measuring the depth of coma based upon
observations of eye opening, speech, and movement. Patients in the deepest level of coma:

 do not respond with any body movement to pain,

 do not have any speech, and

 do not open their eyes.

Those in lighter comas may offer some response, to the point they may even seem wake, yet meet the criteria of coma because they
do not respond to their environment.

The scale is used as part of the initial evaluation of a patient, but does not assist in making the diagnosis as to the cause of coma.
Since it "scores" the level of coma, the GCS can be used as a standard method for any health-caregiver to assess change in patient
status.

Glasgow Coma Scale

Eye Opening  
Spontaneous 4
To loud voice 3
To pain 2
None 1
 
Verbal Response  
Oriented 5
Confused, Disoriented 4
Inappropriate words 3
Incomprehensible words 2
None 1
 
Motor Response  
Obeys commands 6
Localizes pain 5
Withdraws from pain 4
Abnormal flexion posturing 3
Extensor posturing 2
None 1

Levels of consciousness

Clouding of consciousness is a very mild form of altered mental status in which the patient has inattention and reduced wakefulness.

Confusional state is a more profound deficit that includes disorientation, bewilderment, and difficulty following commands.

Lethargy consists of severe drowsiness in which the patient can be aroused by moderate stimuli and then drift back to sleep.
Obtundation is a state similar to lethargy in which the patient has a lessened interest in the environment, slowed responses to
stimulation, and tends to sleep more than normal with drowsiness in between sleep states.

Stupor means that only vigorous and repeated stimuli will arouse the individual, and when left undisturbed, the patient will immediately
lapse back to the unresponsive state.

Coma is a state of unarousable unresponsiveness.