SHOCK

SHOCK

What is it Shock:



Shock occurs when your blood pressure

Shock occurs when your blood pressure

falls to a very low level. As your blood

falls to a very low level. As your blood

pressure falls, your brain and other organs

pressure falls, your brain and other organs

don't get enough blood or oxygen to

don't get enough blood or oxygen to

function, and they begin to fail. Shock can

function, and they begin to fail. Shock can

arise from any of a number of causes. It is a

arise from any of a number of causes. It is a

life-threatening medical emergency and

life-threatening medical emergency and

must be treated early to avoid serious

must be treated early to avoid serious

complications and even death.

complications and even death.

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

Types of shock:

Types of shock:



Hypovolaemic shock

Hypovolaemic shock



Cardiogenic shock

Cardiogenic shock



Distributive shock

Distributive shock



Obstructive shock

Obstructive shock



Endocrine shock

Endocrine 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 or severe

burns

.

Hipovolaemic shock

Signs and symptoms



Anxiety, restlessness,

Anxiety, restlessness,

altered mental state

altered mental state

due to

due to

decreased cerebral perfusion and

decreased cerebral perfusion and

subsequent hypoxia.

subsequent hypoxia.



Hypotension due to decrease in

Hypotension due to decrease in

circulatory volume.

circulatory volume.



A rapid, weak, thready pulse due to

A rapid, weak, thready pulse due to

decreased blood flow combined with

decreased blood flow combined with

tachycardia.

tachycardia.



Cool, clammy skin due to

Cool, clammy skin due to

vasoconstriction and stimulation of

vasoconstriction and stimulation of

vasoconstriction.

vasoconstriction.



Rapid and shallow respirations due to

Rapid and shallow respirations due to

sympathetic nervous system

sympathetic nervous system

stimulation and acidosis.

stimulation and acidosis.



Hypothermia due to decreased

Hypothermia due to decreased

perfusion and evaporation of sweat.

perfusion and evaporation of sweat.



Thirst and dry mouth.

Thirst and dry mouth.



Fatigue due to inadequate

Fatigue due to inadequate

oxygenation.

oxygenation.

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.

symptoms:



similar to hypovolaemic shock but in

similar to hypovolaemic shock but in

addition:

addition:



Distended

Distended

veins

veins

due to increased

due to increased

venous pressure

venous pressure

.

.



Absent pulse due to tachy

Absent pulse due to tachy

arrhythmia

arrhythmia

.

.

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

Anaphylactic shock

Neurogenic shock

Septic shock

Septic shock

Septic shock

Septic shock

- This is caused by an overwhelming

- This is caused by an overwhelming

infection leading to

infection leading to

vasodilation

vasodilation

, such as by

, such as by

Gram negative

Gram negative

bacteria i.e.

bacteria i.e.

Escherichia coli

Escherichia coli

, Proteus

, Proteus

species,

species,

Klebsiella pneumoniae

Klebsiella pneumoniae

which release an

which release an

endotoxin

endotoxin

which produces adverse biochemical,

which produces adverse biochemical,

immunological and occasionally neurological effects

immunological and occasionally neurological effects

which are harmful to the body.

which are harmful to the body.

Gram-positive

Gram-positive

cocci,

cocci,

such as

such as

pneumococci

pneumococci

and

and

streptococci

streptococci

, and certain

, and certain

fungi as well as Gram-positive bacterial toxins

fungi as well as Gram-positive bacterial toxins

produce a similar syndrome.

produce a similar syndrome.

Symptoms:Septic shock, similar to hypovolaemic

Symptoms:Septic shock, similar to hypovolaemic

shock except in the first stages:

shock except in the first stages:



Pyrexia and fever, or

Pyrexia and fever, or

hyperthermia

hyperthermia

, due to

, due to

overwhelming bacterial infection.

overwhelming bacterial infection.



Vasodilation and increased

Vasodilation and increased

cardiac output

cardiac output

due to

due to

sepsis

sepsis

.

.

Neurogenic shock-is the rarest form of

Neurogenic shock-is the rarest form of

shock. It is caused by

shock. It is caused by

trauma

trauma

to the

to the

spinal cord

spinal cord

resulting in the sudden loss of

resulting in the sudden loss of

autonomic

autonomic

and

and

motor

motor

reflexes below the

reflexes below the

injury level. Without stimulation by

injury level. Without stimulation by

sympathetic nervous system

sympathetic nervous system

the vessel walls

the vessel walls

relax uncontrolled, resulting in a sudden

relax uncontrolled, resulting in a sudden

decrease in

decrease in

peripheral vascular resistance

peripheral vascular resistance

,

,

leading to

leading to

vasodilation

vasodilation

and

and

hypotension

hypotension

.

.

Neurogenic shock

Neurogenic shock

, similar to hypovolaemic

, similar to hypovolaemic

shock except in the skin's characteristics. In

shock except in the skin's characteristics. In

neurogenic shock, the skin is warm and dry.

neurogenic shock, the skin is warm and dry.



Anaphylactic shock

Anaphylactic shock



Skin rush and large hives.

Skin rush and large hives.



Localised

Localised

edema

edema

, especially around

, especially around

the face.

the face.



Weak and rapid pulse.

Weak and rapid pulse.



Breathlessness and cough due to

Breathlessness and cough due to

narrowing of airways

narrowing of airways

and

and

swelling of the throat

swelling of the throat

.

.

Obstructive Shock

Obstructive Shock

1)

1)

Cardiac tamponade

Cardiac tamponade

- in which blood

- in which blood

in the pericardium prevents inflow of

in the pericardium prevents inflow of

blood into the heart (venous return).

blood into the heart (venous return).

2)

2)

Tension pneumothorax

Tension pneumothorax

- Through

- Through

increased intrathoracic pressure,

increased intrathoracic pressure,

bloodflow to the heart is prevented

bloodflow to the heart is prevented

(venous return).

(venous return).

3)Massive

3)Massive

pulmonary embolism

pulmonary embolism

is the

is the

result of a thromboembolic incident in

result of a thromboembolic incident in

the bloodvessels of the

the bloodvessels of the

lungs

lungs

and

and

hinders the return of blood to the

hinders the return of blood to the

heart.

heart.

4)

4)

Aortic stenosis

Aortic stenosis

- hinders circulation

- hinders circulation

by obstructing the

by obstructing the

ventricular outflow tract

ventricular outflow tract

Treatment:



Depending on the type or the cause of the

Depending on the type or the cause of the

shock, treatments will differ. In general, fluid

shock, treatments will differ. In general, fluid

resuscitation (giving a large amount of fluid to

resuscitation (giving a large amount of fluid to

raise blood pressure quickly) with an IV in the

raise blood pressure quickly) with an IV in the

ambulance or emergency room is the first–line

ambulance or emergency room is the first–line

treatment for all types of shock. The doctor will

treatment for all types of shock. The doctor will

also administer medications such as

also administer medications such as

epinephrine, norepinephrine or dopamine to the

epinephrine, norepinephrine or dopamine to the

fluids to try to raise a patient's blood pressure

fluids to try to raise a patient's blood pressure

to ensure blood flow to the vital organs.

to ensure blood flow to the vital organs.



Tests (for example, x–rays, blood tests,

Tests (for example, x–rays, blood tests,

EKGs

EKGs

)

)

will determine the underlying cause of the shock

will determine the underlying cause of the shock

and uncover the severity of the patient's illness.

and uncover the severity of the patient's illness.



A compromise must be found

A compromise must be found

between:

between:



raising the blood pressure to be able

raising the blood pressure to be able

to transport "safely" (when the blood

to transport "safely" (when the blood

pressure is too low, any motion can

pressure is too low, any motion can

lower the heart and brain perfusion,

lower the heart and brain perfusion,

and thus cause death);

and thus cause death);



respecting the

respecting the

golden hour

golden hour

. If surgery

. If surgery

is required, it should be performed

is required, it should be performed

within the first hour to maximise the

within the first hour to maximise the

patient's chance of survival.

patient's chance of survival.

FLUIDS:

FLUIDS:



Crystalloids - Such as sodium chloride (0.9%), or

Crystalloids - Such as sodium chloride (0.9%), or

Hartmann's solution (Ringer's lactate). Dextrose

Hartmann's solution (Ringer's lactate). Dextrose

solutions which contain free water are less effective

solutions which contain free water are less effective

at re-establishing circulating volume, and promote

at re-establishing circulating volume, and promote

hyperglycaemia.

hyperglycaemia.



Colloids - For example, synthetic albumin

Colloids - For example, synthetic albumin

(Dextran™), polygeline (Haemaccel™), succunylated

(Dextran™), polygeline (Haemaccel™), succunylated

gelatin (Gelofusine™) and hetastarch (Hepsan™).

gelatin (Gelofusine™) and hetastarch (Hepsan™).

Colloids are, in general, much more expensive than

Colloids are, in general, much more expensive than

crystalloid solutions and have not conclusively been

crystalloid solutions and have not conclusively been

shown to be of any benefit in the initial treatment

shown to be of any benefit in the initial treatment

of shock.

of shock.



Combination - Some clinicians argue that

Combination - Some clinicians argue that

individually, colloids and crystalloids can further

individually, colloids and crystalloids can further

exacerbate the problem and suggest the

exacerbate the problem and suggest the

combination of crystalloid and colloid solutions.

combination of crystalloid and colloid solutions.



Blood - Essential in severe haemorrhagic shock,

Blood - Essential in severe haemorrhagic shock,

often pre-warmed and rapidly infused.

often pre-warmed and rapidly infused.



Vasoconstrictor agents have no role in

Vasoconstrictor agents have no role in

the initial treatment of hemorrhagic

the initial treatment of hemorrhagic

shock, due to their relative inefficacy

shock, due to their relative inefficacy

in the setting of acidosis, and due to

in the setting of acidosis, and due to

the fact that the body, in the setting of

the fact that the body, in the setting of

hemorrhagic shock, is in an

hemorrhagic shock, is in an

endogenously catecholaminergic state.

endogenously catecholaminergic state.

Definitive care and control of the

Definitive care and control of the

hemorrhage is absolutely necessary,

hemorrhage is absolutely necessary,

and should not be delayed.

and should not be delayed.

Self–Care at Home



Call 999 or 112 for immediate medical attention

Call 999 or 112 for immediate medical attention

any time a person has symptoms of shock. Do

any time a person has symptoms of shock. Do

not wait for symptoms to worsen before calling

not wait for symptoms to worsen before calling

for help. Stay with the person until help

for help. Stay with the person until help

arrives.

arrives.



While waiting for help or on the way to the

While waiting for help or on the way to the

emergency room, check the person's airway,

emergency room, check the person's airway,

breathing and circulation (the ABCs).

breathing and circulation (the ABCs).

Administer CPR if you are trained. If the person

Administer CPR if you are trained. If the person

is breathing on his or her own, continue to

is breathing on his or her own, continue to

check breathing every five minutes until help

check breathing every five minutes until help

arrives.

arrives.



Have the person lie down on his or her back

Have the person lie down on his or her back

with the feet elevated above the head (if

with the feet elevated above the head (if

raising the legs causes pain or injury, keep the

raising the legs causes pain or injury, keep the

person flat) to increase blood flow to vital

person flat) to increase blood flow to vital

organs. Do not raise the head.

organs. Do not raise the head.



Do NOT move a person who has a known or

Do NOT move a person who has a known or

suspected spinal injury.

suspected spinal injury.



Keep the person warm and comfortable. Loosen

Keep the person warm and comfortable. Loosen

tight clothing and cover them with a blanket.

tight clothing and cover them with a blanket.



Do not give fluids by mouth, even if the person

Do not give fluids by mouth, even if the person

complains of thirst. There is a choking risk in the

complains of thirst. There is a choking risk in the

event of sudden loss of consciousness.

event of sudden loss of consciousness.



Give appropriate

Give appropriate

first aid

first aid

for any injuries.

for any injuries.

Can shock be prevented?



Learn ways to prevent heart disease,

Learn ways to prevent heart disease,

injuries, dehydration and other causes

injuries, dehydration and other causes

of shock.

of shock.



If you have a known allergy, carry an

If you have a known allergy, carry an

epinephrine pen, which your doctor

epinephrine pen, which your doctor

can prescribe

can prescribe

What is the outlook for

shock?



The outlook depends on the cause of the shock, the

The outlook depends on the cause of the shock, the

general health of the patient, and the promptness of

general health of the patient, and the promptness of

treatment and recovery.

treatment and recovery.



Generally, hypovolemic shock and anaphylactic shock

Generally, hypovolemic shock and anaphylactic shock

respond well to medical treatment if initiated early.

respond well to medical treatment if initiated early.



Septic shock is a serious condition which can have a

Septic shock is a serious condition which can have a

mortality rate of 40%–75% according to some estimates.

mortality rate of 40%–75% according to some estimates.

The sooner the infection is treated and fluids are

The sooner the infection is treated and fluids are

administered, the greater the chances of success.

administered, the greater the chances of success.



Cardiogenic shock has a poor prognosis, with only 1/3 of

Cardiogenic shock has a poor prognosis, with only 1/3 of

patients surviving. Because this type of shock results

patients surviving. Because this type of shock results

from injury or dysfunction of the heart it is often difficult

from injury or dysfunction of the heart it is often difficult

to treat and overcome.

to treat and overcome.



Spinal shock also has a very poor prognosis because the

Spinal shock also has a very poor prognosis because the

spinal cord mediates so many important bodily functions.

spinal cord mediates so many important bodily functions.

There are currently very few effective treatments but

There are currently very few effective treatments but

medical research is making advances in the treatment of

medical research is making advances in the treatment of

spinal injuries.

spinal injuries.

THANK YOU FOR

THANK YOU FOR

ATTENCION

ATTENCION

FRIENDS

FRIENDS



BIBLIOGRAPHY:

BIBLIOGRAPHY:

MedlinePlus, Wikipedia,  Mayoclinic.com, American Medical

MedlinePlus, Wikipedia,  Mayoclinic.com, American Medical

Association Encyclopedia of Medicine, eMedicne.com, "Septic Shock." The Chinese University of Hong

Association Encyclopedia of Medicine, eMedicne.com, "Septic Shock." The Chinese University of Hong

Kong.

Kong.