SHOCK

 A clinical syndrome marked by inadequate perfusion and oxygenation of cells, tissues and organs, usually as a result of severe or markedly lowered blood pressure. The shock syndrome is a life-threatening medical emergency and requires very careful therapy and monitoring.

Type of Shock: Based on causes of shock

1. Cardiogenic shock-

  • Failure of the heart to pump an adequate supply of blood and oxygen to body tissues.
  • The most common cause of cardiogenic shock is acute myocardial infarction.
2. Anaphylactic shock-

  • Rapidly developing, systemic anaphylaxis that produces life-threatening acute airway obstruction and vascular collapse within minutes after exposure to an antigen.
  • The most common cause is a type I allergic or hypersensitivity reaction.
  • The most common agents are bee or wasp venoms, drugs (e.g. penicillin) and radiographic contrast media.
3. Hypovolemic shock-

  • Shock occurring when there is an insufficient amount of fluid in the circulatory system.
  • Most common causes are excessive bleeding, diarrhea, vomiting, fluid loss from fistulas or burns and third space shifting of fluid into the abdominal cavity (ascites) or other intestinal tissue (edema).
4. Neurogenic shock-

  • A form of shock due to decreased peripheral vascular resistance caused by damage to either the brain or the spinal cord.
  • The decreased peripheral vascular resistance (vasodilation) and subsequent pooling of blood within peripheral vessels results in hypotension and warm, dry or pink skin.
5. Septic shock-

  • Shock as the result of sepsis (the presence of pathogens in the bloodstream).
  • The most common organism are gram-negative (common) and gram-positive bacteria, but fungi and other organisms may also be responsible.
6. Hypoglycemic shock or insulin shock-

  • Shock produced by extremely low blood sugars (e.g. less than 40mg/dl) usually caused by an injection of an excessive amount of insulin, failure  to eat after an insulin injection and insulinomas (insulin secreting tumors which cause hypoglycemia).
  • Insulin-related hypoglycemic shock may be intentionally induced in the treatment of certain psychiatric conditions.
Clinical Manifestation:

  • Shock results in failure of multiple organ systems including the brain, heart, kidney , lungs, skin and gastrointestinal tract.
  • Subjective (symptom): Restlessness, Paresis of extremities, Confusion, Syncope
  • Objective (sign): Weak, rapid, thready pulse (tachycardia); Shallow, rapid respiration (tachypnea); Diaphoresis; Cold, clammy and cyanotic skin (except neurogenic shock); Pallor; Decreased  urine output (oliguria); Progressive loss of consciousness; Decreased mean arterial pressure (normal is 80 to 120 mm Hg).
Management:

  • The shock syndrome  is a life-threatening medical emergency and requires very careful therapy and monitoring 
  • Attempts to restore normal blood pressure and tissue perfusion include:-
            - Fluid resuscitation (in hypovolemic shock)

            - Control of hemorrhage (in shock caused by trauma or bleeding).

            - Administer corticosteroids and antihistamine such as chlorpheniramine maleate,                  cetirizine etc. in anaphylactic shock.

            - Administration digoxin for pressor support (in cardiogenic) and antibiotic (in septic                shock).

            - Administration of epinephrine (in anaphylaxis or neurogenic shock for peripheral                     vasoconstriction).

            - Administration oral or parenterally sugars, typically glucose (in hypoglycemia or                 insulinomas).  

  • Insert indwelling urinary catheter to track urine output hourly.
  • SaO2, arterial blood gas levels (ABGs), and ventilatory functions are monitored to determine the need for ventilatory support.
  • Suitable position used during shock is trendelenburg position.





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