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As blood pressure falls, brain and other organs don't get enough blood or oxygen to function, and they begin to fail. Shock can arise from any of a number of causes. It is a lifethreatening medical emergency and must be treated early to avoid serious complications and even death. The following conditions and characteristics increase the risk for shock:
• • • • • • • • • • • •
Serious injury and trauma Heart conditions such as heart disease or heart attack Surgery Bacterial infection that has spread to the blood Bleeding Losing large volume of fluids from severe diarrhea or vomiting Excessive alcohol use Severe anemia Weakened immune system Allergic reaction to a drug, food, or environmental exposure Drug overdose Pregnancy
Common signs and symptoms of shock include: Low blood pressure • Altered mental state, including reduced alertness and awareness, confusion, and sleepiness • Cold, moist skin. Hands and feet may be blue or pale • Weak or rapid pulse • Rapid breathing and hyperventilation • Decreased urine output • In septic shock (from overwhelming blood infection) -- shaking chills, rapid temperature increase, warm, flushed skin, and rapid pulse • In shock related to heart problems -- lung congestion, rapid pulse, heart murmur, enlarged neck veins
Direct loss of effective circulating blood volume leading to: • Anxiety. the heart doesn't pump enough blood through the body. clammy vasoconstriction skin due to vasoconstriction and stimulation of • • • • Rapid and shallow respirations due to sympathetic nervous system stimulation and acidosis Hypothermia due to decreased perfusion and evaporation of sweat Thirst and dry mouth. Heart problems (cardiogenic shock) -. altered mental state due to decreased cerebral perfusion and subsequent hypoxia Hypotension due to decrease in circulatory volume A rapid.In this case. and anaphylactic shock. It can be caused by a heart attack. 3. restlessness. Blood vessels become too dilated (distributive shock) -.CAUSES 1. CLASSIFICATION OF SHOCK Hypovolemic shock This is the most common type of shock and based on insufficient circulating volume. are examples. which is a severe allergic reaction.If the blood vessels expand too much. which occurs when bacteria invade the bloodstream.occurs after heavy bleeding from an injury or a condition such as bleeding ulcers. Loss of fluid in the bloodstream (hypovolemic shock) -. traumatic bleeding. or losing plasma after serious burns). abnormal heart rhythm. Its primary cause is loss of fluid from the circulation (most often "hemorrhagic shock"). weak. Hypovolemic shock can also occur if your body loses too much of fluids other than blood (such as losing water after severe diarrhea or vomiting. or damage to the heart from heart disease. Causes may include internal bleeding. 2. due to fluid depletion • • . high output fistulae or severe burns. thready pulse due to decreased blood flow combined with tachycardia Cool. Septic shock. they are not able to keep blood circulating to all organs.
Signs are similar to hypovolemic shock but in addition: • • • Distended jugular veins due to increased jugular venous pressure Weak or absent pulse Arrhythmia. In 1992. Proteus species. This form of "relative" hypovolemia is the result of dilation of blood vessels which diminishes systemic vascular resistance. such as pneumococci and streptococci. This can be due to damage to the heart muscle. and certain fungi as well as Gram-positive bacterial toxins. cardiomyopathy. Examples of this form of shock are: Septic shock. the ACCP/SCCM Consensus Conference Committee defined septic shock: ". Klebsiella pneumoniae which release an endotoxin which produces adverse biochemical. but are not limited . often with pupils dilated • Cardiogenic shock This type of shock is caused by the failure of the heart to pump effectively. It is caused by an overwhelming systemic infection resulting in vasodilation leading to hypotension. . often tachycardic Distributive shock As in hypovolemic shock there is an insufficient intravascular volume of blood. . due to insufficient perfusion of the skin Distracted look in the eyes or staring into space. Septic shock also includes some elements of cardiogenic shock.sepsis-induced hypotension (systolic blood pressure <90 mm Hg or a reduction of 40 mm Hg from baseline) despite adequate fluid resuscitation along with the presence of perfusion abnormalities that may include. most often from a large myocardial infarction.• • Fatigue due to inadequate oxygenation Cold and mottled skin (cutis marmorata). Septic shock can be caused by Gram negative bacteria such as (among others) Escherichia coli. and other Gram-positive cocci. Other causes of cardiogenic shock include arrhythmias. immunological and occasionally neurological effects which are harmful to the body. cardiac valve problems. especially extremities. CHF.
leading to vasodilation and hypotension. Signs are similar to hypovolemic shock except in the first stages: • • • • • • • Pyrexia (fever). oliguria. leading to hypotension and increased capillary permeability. It is caused by a severe anaphylactic reaction to an allergen. especially around the face Weak and rapid pulse Breathlessness and cough due to narrowing of airways and swelling of the throat Neurogenic shock. due to increased level of cytokines Systemic vasodilation resulting in hypotension (low blood pressure) Warm and sweaty skin due to vasodilation Systemic leukocyte adhesion to endothelial tissue Reduced contractility of the hear Activation of the coagulation pathways. resulting in disseminated intravascular coagulation Increased levels of neutrophils Anaphylactic shock. or an acute alteration in mental status. it is the rarest form of shock. resulting in a sudden decrease in peripheral vascular resistance.) .to. antigen. Without stimulation by sympathetic nervous system the vessel walls relax uncontrollably. lactic acidosis. (This term can be confused with Spinal shock which is a recoverable loss of function of the spinal cord after injury and does not refer to the hemodynamic instability per se. • • • • Skin eruptions and large bumps Localized edema. drug or foreign protein causing the release of histamine which causes widespread vasodilation. It is caused by trauma to the spinal cord resulting in the sudden loss of autonomic and motor reflexes below the injury level. Patients who are receiving inotropic or vasopressor agents may have a normalized blood pressure at the time that perfusion abnormalities are identified.
blood flow to the heart is prevented (venous return). Massive pulmonary embolism is the result of a thromboembolic incident in the bloodvessels of the lungs and hinders the return of blood to the heart.• As with hypovolemic shock but in high spinal injuries may also be accompanied by profound bradycardia due to loss of the cardiac accelerating nerve fibres from the sympathetic nervous system at T1-T4. in which the pericardiumshrinks and hardens. Similar to hypovolemic shock but in addition: • • Distended jugular veins due to increased jugular venous pressure Pulsus paradoxus in case of tamponade Cardiac tamponade in which fluid in the pericardium prevents inflow of blood into the heart (venous return). Constrictive pericarditis. Several conditions result in this form of shock. above which the skin is diaphoretic. Aortic stenosis hinders circulation by obstructing the ventricular outflow tract . is similar in presentation. Tension pneumothorax. Through increased intrathoracic pressure. Priapism due to Peripheral nervous system stimulation Obstructive shock In this situation the flow of blood is obstructed which impedes circulation and can result in circulatory arrest. • • The skin is warm and dry or a clear sweat line exists.
If the person is experiencing trouble breathing. If the person is conscious but has trouble breathing. or an endotracheal tube and ventilator. Lay the person flat on the back and raise the legs about 25 cm to help restore the blood pressure. The type of fluids administered and the speed of delivery vary. The most common and serious side effect of fluid replacement are cardiovascular overload and pulmonary edema. Check the person’s rate of breathing and circulation every 5 minutes. *Close monitoring of the patients during fluid is necessary to identify side effects and complications. To deal with underlying conditions such as heart problems. may include crystalloids (electrolyte solutions that move freely between intravascular and isterstitial space). Administer first aid treatment to wounds. Treating shock with the following guidelines to make a difference: • • • • • • Call a doctor or emergency services for medical help immediately. drugs are administered or surgery may be performed. colloids (large-molecule intravenous solutions) or blood components. but fluids are given to improve cardiac and tissue oxygenation. Do not give the person food or liquids to prevent inhalation of vomit.MANAGEMENT When someone goes into shock. . Loosen tight clothing and keep person warm and comfortable. To treat him or her effectively. injuries or illnesses. place him or her in a sitting position. treatment is needed immediately. • • Extra oxygen is administered either by a tube in the nose. Emergency treatment would involve the person in shock being hospitalized. Give fluids and blood intravenously to improve the blood flow. A ventilator is used if the patient has trouble breathing. Bacterial infections will be treated with antibiotics. FLUID REPLACEMENT Is administered in all types of shocks. treating shock will include: • • Temperature control such as cooling blankets or warming devices. a face mask. begin CPR.
some people do recover while others may need long-term care. Hypovolemic shock is treated with fluids (saline) in minor cases. immobilization (keeping the spine from moving). In severe or prolonged cases. but may require multiple blood transfusions in severe cases. Anaphylactic shock is treatedwith diphenhydramine (Benadryl). These patients are often dehydrated and require large amounts of fluids to increase and maintain blood pressure. Neurogenic shock is the most difficult to treat. a heart transplant may be the only treatment. steroid medications methylprednisolone (Solu-Medrol) and sometimes a H2-Blocker medication. anti-inflammatory medicine such as steroids. it is usually fatal. Depending on the severity of the condition associated with shock and symptoms. Besides fluids and monitoring. The underlying cause of the bleeding must also be identified and corrected. . A patient with a heart attack may require a surgical procedure called a cardiac catheterization to unblock an artery. and sometimes surgery are the main parts of treatment. epinephrine (an "Epi-pen"). Cardiogenic shock is treated by identifying and treating the underlying cause. Septic shock is treated with prompt administration of antibiotics depending on the source and type of underlying infection. A patient with congestive heart failure may need medications to support and increase the force of the heart's beat.If physiological shock is left untreated. Damage to the spinal cord is often irreversible and causes problems with the natural regulatory functions of the body.
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