This article is about a medical condition. For other uses, see Shock (disambiguation).

Shock is a serious medical condition where the tissue perfusion is insufficient to meet the required supply of oxygen and nutrients. This hypoperfusion state is a life-threatening medical emergency and one of the leading causes of death in a critically ill person. This primary cause may lead to many other medical emergencies, such as hypoxia or cardiac arrest.^{[1] [2] [3] [4] [5]} The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) is a detailed description of known diseases and injuries. ... The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... // R00-R99 - Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R09) Symptoms and signs involving the circulatory and respiratory systems (R00) Abnormalities of heart beat (R000) Tachycardia, unspecified (R001) Bradycardia, unspecified (R002) Palpitations (R008) Other and unspecified abnormalities of heart beat (R01) Cardiac murmurs and other... The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) is a detailed description of known diseases and injuries. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Diseases Database is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... Shock may refer to: Look up shock in Wiktionary, the free dictionary. ... See drugs, medication, and pharmacology for substances that are used to treat patients. ... Biological tissue is a collection of interconnected cells that perform a similar function within an organism. ... Perfusion is a physiological term that refers to the process of nutritive delivery of arterial blood to a capillary bed in the biological tissue. ... General Name, Symbol, Number oxygen, O, 8 Chemical series Nonmetals, chalcogens Group, Period, Block 16, 2, p Appearance colorless (gas) very pale blue (liquid) Atomic mass 15. ... Nutrients and the body A nutrient is any element or compound necessary for or contributing to an organisms metabolism, growth, or other functioning. ... A medical emergency is an injury or illness that poses an immediate threat to a persons health or life which requires help from a doctor or hospital. ... This article or section does not cite its references or sources. ... Hypoxia may refer to: Hypoxia (medical), the lack of oxygen in tissues Hypoxia or Oxygen depletion, a reduced concentration of dissolved oxygen in a water body leading to stress or even death in aquatic organisms This is a disambiguation page: a list of articles associated with the same title. ...

Stages of shock

Effects of inadequate perfusion on cell function.

There are four stages of shock.^[6] Image File history File links Shock-cell2. ... Image File history File links Shock-cell2. ...

• Initial - During this stage, the hypoperfusional state causes hypoxia, leading to the mitochondria being unable to produce adenosine triphosphate. Due to this lack of oxygen, the cell membranes become damaged and the cells perform anaerobic respiration. This causes a build-up of lactic and pyruvic acid which results in systemic metabolic acidosis. The process of removing these compounds from the cells by the liver requires oxygen, which is absent.
• Compensatory - This stage is characterised by the body employing physiological mechanisms, including neural, hormonal and bio-chemical mechanisms in an attempt to reverse the condition. As a result of the acidosis, the person will begin to hyperventilate in order to rid the body of carbon dioxide (CO₂). CO₂ indirectly acts to acidify the blood and by removing it the body is attempting to raise the pH of the blood. The baroreceptors in the arteries detect the resulting hypotension, and cause the release of adrenaline and noradrenaline. These cause widespread vasoconstriction resulting in an increase in not only blood pressure but heart rate. Renin-angiotensin axis is activated and antidiuretic hormone is released to conserve fluid via the kidneys. Also, these hormones cause the vasoconstriction of the kidneys, gastrointestinal tract, and other organs to divert blood to the heart, lungs and brain. The lack of blood to the renal system causes the characteristic low urine production.
• Progressive - Should the cause of the crisis not be successfully treated, the shock will proceed to the progressive stage and the compensatory mechanisms begin to fail. Due to the decreased perfusion of the cells, sodium ions build up within while potassium ions leak out. As anaerobic metabolism continues, increasing the body's metabolic acidosis, the arteriolar and precapillary sphincters constrict such that blood remains in the capillaries. Due to this, the hydrostatic pressure will increase and, combined with histamine release, this will lead to leakage of fluid and protein into the surrounding tissues. As this fluid is lost, the blood concentration and viscosity increase, causing sludging of the micro-circulation. The prolonged vasoconstriction will also cause the vital organs to be compromised due to reduced perfusion.
• Refractory - At this stage, the vital organs have failed and the shock can no longer be reversed. Brain damage and cell death have occurred. Death will occur imminently.

Shock is a complex and continuous condition and there is no sudden transition from one stage to the next. Hypoxia is a pathological condition in which the body as a whole (generalised hypoxia) or region of the body (tissue hypoxia) is deprived of adequate oxygen supply. ... In cell biology, a mitochondrion is an organelle found in the cells of most eukaryotes. ... Adenosine 5-triphosphate (ATP), discovered in 1929 by Karl Lohmann,[1] is a multifunctional nucleotide primarily known in biochemistry as the molecular currency of intracellular energy transfer. ... Drawing of a cell membrane A component of every biological cell, the cell membrane (or plasma membrane) is a thin and structured bilayer of phospholipid and protein molecules that encapsulate the cell. ... It has been suggested that this article or section be merged with Fermentation (biochemistry). ... Lactic acid (IUPAC systematic name: 2-hydroxypropanoic acid), also known as milk acid, is a chemical compound that plays a role in several biochemical processes. ... Pyruvic acid (CH3COCO2H) is an alpha-keto acid which plays an important role in biochemical processes. ... In medicine, metabolic acidosis is a state in which the blood pH is low (under 7. ... The liver is an organ in living beings, including humans. ... Acidosis is an increased acidity (i. ... In medicine, hyperventilation, also known as hyperpnea, is the state of breathing faster or deeper (hyper) than necessary, and thereby reducing the carbon dioxide concentration of the blood below normal. ... Baroreceptors (or baroceptors) in the human body detect the pressure of blood flowing though them, and can send messages to the central nervous system to increase or decrease total peripheral resistance and cardiac output. ... Section of an artery For other uses see Artery (disambiguation) Arteries are muscular blood vessels that carry blood away from the heart. ... In physiology and medicine, hypotension refers to an abnormally low blood pressure. ... Epinephrine (INN) or adrenaline (BAN) is a hormone and a neurotransmitter. ... Norepinephrine, known as noradrenaline outside the USA, is a catecholamine and a phenethylamine with chemical formula C8H11NO3. ... The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... A sphygmomanometer, a device used for measuring blood pressure. ... The heart and lungs, from an older edition of Grays Anatomy. ... Kidneys viewed from behind with spine removed The kidneys are bean-shaped excretory organs in vertebrates. ... The gastrointestinal tract or digestive tract, also referred to as the GI tract or the alimentary canal, (nourishment canal) or the gut, is the system of organs within multicellular animals which takes in food, digests it to extract energy and nutrients, and expels the remaining waste. ... The heart and lungs (from an older edition of Grays Anatomy) The lung is an organ belonging to the respiratory system and interfacing to the circulatory system of air-breathing vertebrates. ... In animals, the brain, or encephalon (Greek for in the head), is the control center of the central nervous system. ... Kidneys viewed from behind with spine removed The kidneys are bean-shaped excretory organs in vertebrates. ... This article or section is in need of attention from an expert on the subject. ... General Name, Symbol, Number sodium, Na, 11 Chemical series alkali metals Group, Period, Block 1, 3, s Appearance silvery white Atomic mass 22. ... General Name, Symbol, Number potassium, K, 19 Chemical series alkali metals Group, Period, Block 1, 4, s Appearance silvery white Atomic mass 39. ... From late Latin sphincter, from Greek sphinkter, band, contractile muscle, from sphingein, to bind tight. ... The word capillary is used to describe any very narrow tube or channel through which a fluid can pass. ... This article or section does not cite its references or sources. ... A representation of the 3D structure of myoglobin, showing coloured alpha helices. ... The pitch drop experiment at the University of Queensland. ... Brain damage or brain injury is the destruction or degeneration of brain cells. ...

Types of shock

In 1972 Hinshaw and Cox suggested the following classification which is still used today.^[1] It uses four types of shock: hypovolaemic, cardiogenic, distributive and obstructive shock:^{[2][3][4][5][7]}

• Hypovolaemic shock - This is the most common type of shock and based on insufficient circulating volume. Its primary cause is loss of fluid from the circulation from either an internal or external source. An internal source may be haemorrhage. External causes may include extensive bleeding, high output fistulae or severe burns.
• Cardiogenic shock - This type of shock is caused by the failure of the heart to pump effectively. This can be due to damage to the heart muscle, most often from a large myocardial infarction. Other causes of cardiogenic shock include arrhythmias, cardiomyopathy, congestive heart failure (CHF), contusio cordis or cardiac valve problems.
• Distributive shock - As in hypovolaemic shock there is an insufficient intravascular volume of blood. This form of "relative" hypovolaemia is the result of dilation of blood vessels which diminishes systemic vascular resistance. Examples of this form of shock are:
  • Septic shock - This is caused by an overwhelming infection leading to vasodilation, such as by Gram negative bacteria i.e. Escherichia coli, Proteus species, Klebsiella pneumoniae which release an endotoxin which produces adverse biochemical, immunological and occasionally neurological effects which are harmful to the body. Gram-positive cocci, such as pneumococci and streptococci, and certain fungi as well as gram-positive bacterial toxins produce a similar syndrome.
  • Anaphylactic shock - Caused by a severe anaphylactic reaction to an allergen, antigen, drug or foreign protein causing the release of histamine which causes widespread vasodilation, leading to hypotension and increased capillary permeability.
  • Neurogenic shock - Neurogenic shock is the rarest form of shock. It is caused by trauma to the spinal cord resulting in the sudden loss of autonomic and motor reflexes below the injury level. Without stimulation by sympathetic nervous system the vessel walls relax uncontrolled, resulting in a sudden decrease in peripheral vascular resistance, leading to vasodilation and hypotension.
• Obstructive shock - In this situation the flow of blood is obstructed which impedes circulation and can result in circulatory arrest. Several conditions result in this form of shock.
  • Cardiac tamponade in which blood in the pericardium prevents inflow of blood into the heart (venous return). Constrictive pericarditis, in which the pericardium shrinks and hardens, is similar in presentation.
  • Tension pneumothorax. Through increased intrathoracic pressure, bloodflow 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.
  • Aortic stenosis hinders circulation by obstructing the ventricular outflow tract

Recently a fifth form of shock has been introduced:^[1] In physiology and medicine, hypovolemia is a state of decreased blood volume; more specifically, decrease in volume of blood plasma. ... Human circulatory system. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... In medicine, a stoma (Greek - plr. ... This article describes a type of injury. ... Cardiogenic shock is based upon an inadequate circulation of blood due to primary failure of the ventricles of the heart to function effectively. ... Acute myocardial infarction (AMI or MI), commonly known as a heart attack, is a disease that occurs when the blood supply to a part of the heart is interrupted. ... Cardiac arrhythmia is a group of conditions in which the muscle contraction of the heart is irregular or is faster or slower than normal. ... Congestive heart failure (CHF), also called congestive cardiac failure (CCF) or just heart failure, is a condition that can result from any structural or functional cardiac disorder that impairs the ability of the heart to fill with or pump a sufficient amount of blood throughout the body. ... Human adult thorax, showing the outline of the heart (in red). ... Grays Fig. ... Headline text Distributive shock is As in hypovolemic shock there is an insufficient volume of blood. ... Vascular resistance is a term used to define the resistance to flow that must be overcome to push blood through the circulatory system. ... Septic shock is a serious medical condition causing such effects as multiple organ failure and death in response to infection and sepsis. ... The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... Gram-negative bacteria are those that do not retain crystal violet dye in the Gram staining protocol. ... ... Endotoxins are potentially toxic, natural compounds found inside pathogens such as bacteria. ... Anaphylaxis is a severe and rapid systemic allergic reaction to a trigger substance, called an allergen. ... In medicine, anaphylaxis is a severe and rapid multi-system allergic reaction. ... An allergen is any substance (antigen), most often eaten or inhaled, that is recognized by the immune system and causes an allergic reaction. ... An antigen is a substance that stimulates an immune response, especially the production of antibodies. ... Oral medication Caffeine is the most widely used psychoactive substance in the world. ... This article or section does not cite its references or sources. ... Neurogenic shock is shock caused by hiv aids the sudden loss of the sympathetic nervous system signals to the smooth muscle in vessel walls. ... In medicine, a trauma patient has suffered serious and life-threatening physical injury resulting in secondary complications such as shock, respiratory failure and death. ... The Spinal cord nested in the vertebral column. ... Anatomy and Physiology of the A.N.S. In contrast to the voluntary nervous system, the involuntary or autonomic nervous system is responsible for homeostasis, maintaining a relatively constant internal environment by controlling such involuntary functions as digestion, respiration, and metabolism, and by modulating energy needed to cope with stressful... ⅔In vertebrates, the term motor neuron (or “motoneuron”) classically applies to neurons located in the central nervous system (CNS) which project their axons outside the CNS and directly or indirectly control muscles. ... Grays FIG. 838– The right sympathetic chain and its connections with the thoracic, abdominal, and pelvic plexuses. ... Total peripheral resistance refers the cumulative resistance of the thousands of arterioles in the body, or the lungs, respectively. ... The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... In physiology and medicine, hypotension refers to an abnormally low blood pressure. ... Cardiogenic shock is based upon an inadequate circulation of blood due to primary failure of the ventricles of the heart to function effectively. ... Cardiac tamponade, also known as pericardial tamponade, is a medical emergency condition where liquid accumulates in the pericardium in a relatively short time. ... In physiology, constrictive pericarditis is due to a thickened, fibrotic pericardium, which prevents the heart from expanding during diastole (relaxation). ... The pericardium is a double-walled sac that contains the heart and the roots of the great vessels. ... A tension pneumothorax is a life threatening condition that results from a progressive deterioration and worsening of a simple pneumothorax, associated with the formation of a one-way valve at the point of rupture. ... The lungs flank the heart and great vessels in the chest cavity. ... Aortic valve stenosis (AS) is a heart condition caused by the incomplete opening of the aortic valve. ... A ventricular outflow tract is a portion of either the left or right ventricle of the human heart through which blood passes in order to enter the great arteries. ...

• Endocrine shock based on endocrine disturbances.
  • Hypothyroidism, in critically ill patients, reduces cardiac output and can lead to hypotension and respiratory insufficiency.
  • Thyrotoxycosis may induce a reversible cardiomyopathy.
  • Acute adrenal insufficiency is frequently the result of discontinuing corticosteroid treatment without tapering the dosage. However, surgery and intercurrent disease in patients on corticosteroid therapy without adjusting the dosage to accommodate for increased requirements may also result in this condition.
  • Relative adrenal insufficiency in critically ill patients where present hormone levels are insufficient to meet the higher demands

The endocrine system is a control system of ductless endocrine glands that secrete chemical messengers called hormones that circulate within the body via the bloodstream to affect distant organs. ... This article or section does not cite its references or sources. ... Cardiac output is the volume of blood being pumped by the heart, in particular a ventricle in a minute. ... Hyperthyroidism (or overactive thyroid gland) is the clinical syndrome caused by an excess of circulating free thyroxine (T4) or free triiodothyronine (T3), or both. ... In medicine, adrenal insufficiency (or hypocortisolism) is the inability of the adrenal gland to produce adequate amounts of cortisol in response to stress. ... In physiology, corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. ... Cortisol is a corticosteroid hormone produced by the adrenal cortex that is involved in the response to stress; it increases blood pressure, blood sugar levels, may cause infertility in women, and suppresses the immune system. ...

Signs and symptoms

• Hypovolaemic shock
  • Anxiety, restlessness, altered mental state due to decreased cerebral perfusion and subsequent hypoxia.
  • Hypotension due to decrease in circulatory volume.
  • A rapid, weak, thready pulse due to decreased blood flow combined with tachycardia.
  • Cool, clammy skin due to vasoconstriction and stimulation of vasonconstriction.
  • Rapid and deep respirations due to sympathetic nervous system stimulation and acidosis.
  • Hypothermia due to decreased perfusion and evaporation of sweat.
  • Thirst and dry mouth, due to fluid depletion.
  • Fatigue due to inadequate oxygenation.
  • Cold and mottled skin (cutis marmorata), especially extremities, due to insufficient perfusion of the skin.
• Cardiogenic shock, similar to hypovolaemic shock but in addition:
  • Distended jugular veins due to increased jugular venous pressure.
  • Absent pulse due to tachyarrhythmia.
• Obstructive shock, similar to hypovolaemic shock but in addition:
  • Distended jugular veins due to increased jugular venous pressure.
  • Pulsus paradoxus in case of tamponade
• Septic shock, similar to hypovolaemic shock except in the first stages:
  • Pyrexia and fever, or hyperthermia, due to overwhelming bacterial infection.
  • Vasodilation and increased cardiac output due to sepsis.
• Neurogenic shock, similar to hypovolaemic shock in its presentation.
• Anaphylactic shock
  • Skin eruptions and large welts.
  • Localised edema, especially around the face.
  • Weak and rapid pulse.
  • Breathlessness and cough due to narrowing of airways and swelling of the throat.

The Glasgow Coma Scale is a neurological scale which seems to give a reliable, objective way of recording the conscious state of a person, for initial as well as continuing assessment. ... Jugular vein - Wikipedia, the free encyclopedia /**/ @import /skins-1. ... A cardiac arrhythmia, also called cardiac dysrhythmia, is a disturbance in the regular rhythm of the heartbeat. ... Jugular vein - Wikipedia, the free encyclopedia /**/ @import /skins-1. ... In medicine, a pulsus paradoxus (PP), also paradoxic pulse and paradoxical pulse, is a sign that is indicative of several conditions including cardiac tamponade and obstructive lung diseases (e. ... This article or section does not cite its references or sources. ... Cardiac output is the volume of blood being pumped by the heart, in particular a ventricle in a minute. ... Sepsis (in Greek Σήψις, putrefaction) is a serious medical condition, resulting from the immune response to a severe infection. ... Edema (American English) or oedema (British English), formerly known as dropsy or hydropsy, is swelling of any organ or tissue due to accumulation of excess lymph fluid, without an increase of the number of cells in the affected tissue. ... Bronchospasm is a difficulty in breathing caused by a sudden constriction of the muscles in the walls of the bronchioles. ... Edema (American English) or oedema (British English), formerly known as dropsy or hydropsy, is swelling of any organ or tissue due to accumulation of excess lymph fluid, without an increase of the number of cells in the affected tissue. ...

Treatment

In the early stages, shock requires immediate intervention to preserve life. Therefore, the early recognition and treatment depends on the transfer to a hospital.

First aid

First aid treatment of shock includes:

• Immediate reassurance and comforting the casualty if conscious.
• If alone, go for help. If not, send someone to go for help and someone stay with the casualty.
• Ensure the patency of the airway and assess breathing. Position in the recovery position if able.
• Attempt to stem any obvious haemorrhaging.
• Cover the patient with a blanket or jacket, but not too thick to cause vasodilation.
• Do not give a drink, moisten lips if requested.
• Prepare for cardiopulmonary resuscitation.
• Give as much information when the ambulance arrives.

The management of shock requires immediate intervention, even before a diagnosis is made. Re-establishing perfusion to the organs is the primary goal through restoring and maintaining the blood circulating volume ensuring oxygenation and blood pressure are adequate; achieving and maintaining effective cardiac function and preventing complications. Patients attending with the symptoms of shock will have, regardless of the type of shock, their airway managed and oxygen therapy initiated. In case of respiratory insufficiency (i.e. diminished levels of consciousness, hyperventilation due to acid-base disturbances or pneumonia) intubation and mechanical ventilation may be necessary. A paramedic may intubate in emergencies outside the hospital, whereas a patient with respiratory insufficiency in-hospital will be intubated usually by a physician. A form of the recovery position. ... A vasodilator is a substance that causes blood vessels in the body to become wider by relaxing the smooth muscle in the vessel wall, or vasodilation. ... Respiratory failure is a medical term for inadequate gas exchange by the respiratory system. ... The Glasgow Coma Scale is a neurological scale which seems to give a reliable, objective way of recording the conscious state of a person, for initial as well as continuing assessment. ... In medicine, hyperventilation (or hyperpnea) is the state of breathing faster or deeper (hyper) than necessary, and thereby reducing the carbon dioxide concentration of the blood below normal. ... An acid-base reaction is a chemical reaction between an acid and a base. ... It has been suggested that CURB-65 be merged into this article or section. ... Intubation being practiced on a dummy (conventional technique using a laryngoscope). ... Bag valve mask In medicine, mechanical ventilation is a method to assist or replace spontaneous breathing. ... The examples and perspective in this article or section may not represent a worldwide view. ... The Doctor by Samuel Luke Fildes This article is about the term physician, one type of doctor; for other uses of the word doctor see Doctor. ...

The aim of these acts is ensure survival during the transportation to the hospital; they do not cure the cause of the shock. Specific treatment depends on the cause.

A compromise must be found between:

• raising the blood pressure to be able to transport "safely" (when the blood pressure is too low, any motion can lower the heart and brain perfusion, and thus cause death);
• respecting the golden hour. If surgery is required, it should be performed within the first hour to maximise the patient's chance of survival.

This is the stay and play versus the load and go debate. In emergency medicine the golden hour is the first sixty minutes after an accident or the onset of acute illness. ...

In-hospital management

Modified and adapted from Alexander M.F., Fawcett J.N. and Runciman, P.N. (2004) Nursing Practice. The Hospital and Home. The Adult. (2nd edition) Edinburgh: Churchill Livingstone

Image File history File links Download high resolution version (878x1195, 92 KB) Summary Modified and adapted from Alexander M.F., Fawcett J.N. and Runciman, P.N. (2004) Nursing Practice. ... Image File history File links Download high resolution version (878x1195, 92 KB) Summary Modified and adapted from Alexander M.F., Fawcett J.N. and Runciman, P.N. (2004) Nursing Practice. ...

Hypovolaemic shock

In hypovolaemic shock, caused by bleeding, it is necessary to immediately control the bleeding and restore the victim's blood volume by giving infusions of balanced salt solutions. Blood transfusions are necessary for loss of large amounts of blood (e.g. greater than 20% of blood volume), but can be avoided in smaller and slower losses. Hypovolemic shock due to burns, diarrhoea, vomiting, etc. is treated with infusions of electrolyte solutions that balance the nature of the fluid lost. Sodium is essential to keep the fluid infused in the extracellular and intravascular space whilst preventing water intoxication and brain swelling. Metabolic acidosis (mainly due to lactic acid) accumulates as a result of poor delivery of oxygen to the tissues, and mirrors the severity of the shock. It is best treated by rapidly restoring intravascular volume and perfusion as above. Inotropic and vasoconstrictive drugs should be avoided, as they may interfere in knowing blood volume has returned to normal.^[1][2][3][4] In physiology and medicine, hypovolemia is a state of decreased blood volume; more specifically, decrease in volume of blood plasma. ... Minor traumatic bleeding from the head Bleeding is the loss of blood from the body. ... Donating blood Blood transfusion is the process of transferring blood or blood-based products from one person into the circulatory system of another. ...

Regardless of the cause, the restoration of the circulating volume is priority. As soon as the airway is maintained and oxygen administered the next step is to commence replacement of fluids via the intravenous route.

Opinion varies on the type of fluid used in shock. The most common are:

• Crystalloids - Such as sodium chloride (0.9%), dextrose (5%) or Hartmann's solution.
• Colloids - For example, synthetic albumin (Dextran™), polygeline (Haemaccel™), succunylated gelatin (Gelofusine™) and hetastarch (Hepsan™).
• Combination - Some clinicians argue that individually, colloids and crystalloids can further exacerbate the problem and suggest the combination of crystalloid and colloid solutions.
• Blood - Essential in severe haemorrhagic shock, often pre-warmed and rapidly infused.

Administration of vasoconstrictors such as adrenaline, noradrenaline and dopamine might be indicated if fluid replacement is insufficient to raise the blood pressure satisfactorily. While attempting to stabilise the patient's condition, it is essential to find the source of the hypovolaemia.

Cardiogenic shock

In cardiogenic shock: depending on the type of myocardal infarction one can infuse fluids or in shock refractory to infusing fluids, inotropic agents. Inotropic agents, which enhance the heart's pumping capabilities, are used to improve the contractility and correct the hypotension. Should that not suffice an intra-aortic balloon pump -which reduces workload for the heart, and improves perfusion of the coronary arteries- can be considered or a left ventricular assist device -which augments the pump-function of the heart.^[1][2][3][4] Cardiogenic shock is based upon an inadequate circulation of blood due to primary failure of the ventricles of the heart to function effectively. ... An inotrope is an agent which increases or decreases the force or energy of muscular contractions. ... The Intra-aortic balloon pump (IABP) is a mechanical device that is used to increase myocardial oxygen supply and decrease myocardial oxygen demand as well as increase cardiac output. ... In cardiac physiology, afterload is the tension produced by a chamber of the heart in order to contract. ... The coronary circulation consists of the blood vessels that supply blood to, and remove blood from, the heart. ... A Ventricular assist device, or VAD, is mechanical device that is used to partially or completely replace the function of a failing heart. ...

The main goals of the treatment of cardiogenic shock are the re-establishment of circulation to the myocardium, minimising heart muscle damage and improving the heart's effectiveness as a pump. This is most often performed by percutaneous coronary intervention and insertion of a stent in the culprit coronary lesion or sometimes by cardiac bypass.

Although this is a protection reaction, the shock itself will induce problems; the circulatory system being less efficient, the body gets "exhausted" and finally, the blood circulation and the breathing slow down and finally stop (cardiac arrest). The main way to avoid this deadly consequence is to make the blood pressure rise again with

• fluid replacement with intravenous infusions;
• use of vasopressing drugs (e.g. to induce vasoconstriction);
• use of antishock trousers that compress the legs and concentrate the blood in the vital organs (lungs, heart, brain).
• use of blankets to keep the patient warm - metallic PET film emergency blankets are used to reflect the patient's body heat back to the patient.

In pharmacology and toxicology, a route of administration is the path by which a drug, fluid, poison or other substance is brought into contact with the body 1. ... The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... Biaxially-oriented polyethylene terephthalate (boPET) polyester film is used for its high tensile strength, chemical and dimensional stability, transparency, gas and aroma barrier properties and electrical insulation. ...

Distributive shock

In distributive shock caused by sepsis the infection is treated with antibiotics and supportive care is given (i.e. inotropica, mechanical ventilation, renal function replacement). Anaphylaxis is treated with adrenaline to stimulate cardiac performance and corticosteroids to reduce the inflammatory response. In neurogenic shock because of vasodilation in the legs, one of the most suggested treatments is placing the patient in the Trendelenburg position, thereby elevating the legs and shunting blood back from the periphery to the body's core. However, since bloodvessels are highly compliant, and expand as result of the increased volume locally, this technique does not work. More suitable would be the use of vasopressors.^[1][2][3][4] Headline text Distributive shock is As in hypovolemic shock there is an insufficient volume of blood. ... Staphylococcus aureus - Antibiotics test plate. ... An inotrope is an agent which increases or decreases the force or energy of muscular contractions. ... Bag valve mask In medicine, mechanical ventilation is a method to assist or replace spontaneous breathing. ... A hemodialysis machine In medicine, hemodialysis, also haemodialysis, is a method for removing waste products such as potassium and urea, as well as free water from the blood when the kidneys are incapable of this (i. ... In medicine, anaphylaxis is a severe and rapid multi-system allergic reaction. ... Epinephrine (INN) or adrenaline (BAN) is a hormone and a neurotransmitter. ... In physiology, corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. ... In medicine, systemic inflammatory response syndrome (SIRS) is an inflammatory state of the whole body (the system). It is characterized by fast heart rate (tachycardia, heart rate >90/min), low blood pressure (systolic <90 or MAP <65), low or high body temperature (<36 or >38 C), high respiratory rate (>20... Neurogenic shock is shock caused by hiv aids the sudden loss of the sympathetic nervous system signals to the smooth muscle in vessel walls. ... Vasoconstriction is the constriction of blood vessels, in other words, when the lumen narrows. ...

Obstructive shock

In obstructive shock the only therapy consist of removing the obstruction. Pneumothorax or haemothorax is treated by inserting a chest tube, pulmonary embolism requires thrombolysis (to reduce the size of the clot), or embolectomy (removal of the thrombus), tamponade is treated by draining fluid from the pericardial space through pericardiocentesis.^[1][2][3][4] Left-sided pneumothorax (on the right side of the image) on CT scan of the chest with chest tube in place. ... A hemothorax (or haemothorax) is a condition that results from blood accumulating in the pleural cavity. ... A chest tube or chest drain is a flexible plastic tube that is inserted through the side of the chest into the pleural space. ... Thrombolysis is the breakdown (lysis) by pharmacological means, of blood clots. ... A thrombus, or blood clot, is the final product of the blood coagulation step in hemostasis. ... The pericardium is a double-walled sac that contains the heart and the roots of the great vessels. ... In medicine, pericardiocentesis is a procedure where fluid is aspirated from the pericardium (the sac enveloping the heart). ...

Endocrine shock

In endocrine shock the hormone disturbances are corrected. Hypothyroidism requires supplementation by means of levothyroxine, in hyperthyroidism the production of hormone by the thyroid is inhibited through thyreostatica, i.e. methimazole (Tapazole®) or PTU (propylthiouracil). Adrenal insufficiency is treated by supplementing corticosteroids. ^[1] This article or section does not cite its references or sources. ... Levothyroxine, also known as L-thyroxine, synthetic T4 or simply 3,5,3,5-tetraiodo-L-thyronine, is a synthetic form of thyroxine (thyroid hormone). ... Hyperthyroidism (or overactive thyroid gland) is the clinical syndrome caused by an excess of circulating free thyroxine (T4) or free triiodothyronine (T3), or both. ... Methimazole is an antithyroid drug similar in action to propylthiouracil. ... Propylthiouracil is a thioamide drug used to treat hyperthyroidism. ...

Prognosis

The prognosis of shock depends on the underlying cause and the nature and extent of concurrent problems. Hypovolemic, anaphylactic and neurogenic shock are readily treatable and respond well to medical therapy. Septic shock however, is a grave condition and with a mortality rate between 30% and 50%. The prognosis of cardiogenic shock is even worse. ^[1]

Shock is said to evolve from reversible to irreversible in experimental hemorrhagic shock involving certain animal species (dogs, rats, mice) that develop intense vasoconstriction of the gut. Death is due to hemorrhagic necrosis of the intestinal lining when shed blood in reinfused. In pigs and humans 1) this is not seen and cessation of bleeding and restoration of blood volume is usually very effective; however 2) prolonged hypovolemia and hypotension does carry a risk of respiratory and then cardiac arrest. Perfusion of the brain may be the greatest danger during shock. Therefore urgent treatment (cessation of bleeding, rapid restoration of circulating blood volume and ready respiratory support) is essential for a good prognosis in hypovolemic shock.

Notes

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References

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• Collins, T. (2000) Understanding Shock. Nursing Standard. Vol. 14(49), pp. 35-41.
• Cuthbertson, B.H. and Webster, N.R. (1995) Nitric oxide in critical care medicine. British Journal of Hospital Medicine. Vol. 54(11), pp. 579-582.
• Hand, H. (2001) Shock. Nursing Standard. Vol. 15(48), pp. 45-55.
• Hobler, K, Napadono,R, Tollerance of Swine to Acute Blood Volume Deficits, Journal of Trauma, 1974, August 14 (8):716-8.
• Irwin, R.S. and Rippe, J.M. (2003) Irwin and Rippe's Intensive Care Medicine (5th edition). Boston: Lippincott, Williams and Wilkins
• Irwin, R.S., Rippe, J.M., Curley, F.J., Heard, S.O. (1997) Procedures and Techniques in Intensive Care Medicine (3rd edition). Boston: Lippincott, Williams and Wilkins.
• Ledingham, I.M. and Ramsey, G. (1986) Shock. British Journal of Anaesthesia Vol. 58, pp. 169-189.
• Marino, P. (1997) The ICU Book. (2nd edition). Philadelphia: Lippincott, Williams and Wilkins.
• Porth, C.M. (2005) Pathophysiology: Concepts of Altered Health States. (7th edition). Philadelphia: Lippincott, Williams and Wilkins
• Sheppard, M. (2005) Principles and practice of high dependency nursing. Edinburgh: Bailliere Tindall.
• Society of Critical Care Medicine. Fundamental Critical Care Support, A standardized curriculum of critical care. SSCM Illinois, 2001.
• Tortora, G.J. (2005) Principles of anatomy and physiology New Jersey: John Wiley, Inc

See also

• Acute respiratory distress syndrome (ARDS)
• Sepsis
• Stress (medicine)
• Physical trauma
• Systemic inflammatory response syndrome (SIRS)