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Encyclopedia > Shock (medical)
Shock
Classification & external resources
ICD-10 many incl. R57.
ICD-9 785
DiseasesDB 12013
MedlinePlus 000039
eMedicine emerg/531  med/285 emerg/533
MeSH D012769

Shock is a serious, often life-threatening medical condition where insufficient blood flow reaches the body tissues. As blood is the body's carrier of oxygen and nutrients, this leads to a deficiency of these essential inputs to life. The process affected, where blood enters the tissues, is called perfusion and this process not occurring properly causes a hypoperfusional (hypo = below) state. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // 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 (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase 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 is a serious medical condition where the tissue perfusion is insufficient to meet the required supply of oxygen and nutrients. ... 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. ... General Name, symbol, number oxygen, O, 8 Chemical series nonmetals, chalcogens Group, period, block 16, 2, p Appearance colorless (gas) very pale blue (liquid) Standard atomic weight 15. ... Nutrients and the body A nutrient is any element or compound necessary for or contributing to an organisms metabolism, growth, or other functioning. ... In physiology, perfusion is the process of nutritive delivery of arterial blood to a capillary bed in the biological tissue. ...


Medical shock must not be confused with the emotional state, and the two are not related. Medical shock is a life-threatening medical emergency and one of the leading causes of death for critically ill people. This primary cause may lead to many other medical emergencies, such as hypoxia (a lack of oxygen in the body tissues) or cardiac arrest (the heart stopping).[1][2][3][4][5][6][7] Acute stress reaction is a psychological condition arising in response to a terrifying event. ... {{Otheruses4|the medical term|the Australian television series|Medical Emergenc an immediate threat to a persons life or long term health. ... 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. ...


Shock can have a number of effects, all with similar outcomes, but all relate to a problem with the body's circulatory system. Key types of shock are:

  • Hypovolemic shock - A lack of blood in the normally closed circulatory system, usually caused by bleeding. (Hypo=low, volemic=volume of blood)
  • Cardiogenic shock - Inefficient pumping of the blood around the body (Cardio=heart)
  • Distributive shock - A range of conditions which prevent the efficient distribution of blood, by dilating blood vessels, leading to a critical drop in blood pressure.
  • Obstructive shock - Another range of conditions where a physical object (such as a blood clot) stops blood from flowing around the body.

Contents

For other uses, see Bleeding (disambiguation). ...

Stages of shock

Effects of inadequate perfusion on cell function.

There are four stages of shock.[8] 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, they become leaky to extra-cellular fluid, 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. Noradrenaline causes predominately vasoconstriction with a mild increase in heart rate, whereas adrenaline predominately causes an increase in heart rate with a small effect on the vascular tone; the combined effect results in an increase in blood pressure. Renin-angiotensin axis is activated and arginine vasopressin 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. However the effects of the Renin-angiotensin axis take time and are of little importance to the immediate homeostatic mediation of shock.
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) is a multifunctional nucleotide that is most important as a 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. ... Anaerobic respiration refers to the oxidation of molecules in the absence of oxygen to produce energy, in opposition to Aerobic respiration which does use oxygen. ... For the production of milk by mammals, see Lactation. ... 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. ... For the bird, see Liver bird. ... 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). ... 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. ... Heart rate is a term used to describe the frequency of the cardiac cycle. ... Epinephrine (INN) or adrenaline (BAN) is a hormone and a neurotransmitter. ... Heart rate is a term used to describe the frequency of the cardiac cycle. ... f you all The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... A sphygmomanometer, a device used for measuring arterial pressure. ... Not to be confused with rennin, the active enzyme in rennet. ... Angiotensin is an oligopeptide in the blood that causes vasoconstriction, increased blood pressure, and release of aldosterone from the adrenal cortex. ... Antidiuretic hormone (ADH), or arginine vasopressin (AVP), is a peptide hormone produced by the hypothalamus, and stored in the posterior part of the pituitary gland. ... Kidneys viewed from behind with spine removed The kidneys are bean-shaped excretory organs in vertebrates. ... Upper and Lower gastrointestinal tract The gastrointestinal tract (GI tract), also called the digestive tract, or the alimentary canal, is the system of organs within multicellular animals that 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. ... For other uses, see Brain (disambiguation). ... 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. ... Not to be confused with rennin, the active enzyme in rennet. ... Angiotensin is an oligopeptide in the blood that causes vasoconstriction, increased blood pressure, and release of aldosterone from the adrenal cortex. ... Homeostasis or homoeostasis is the property of an open system, especially living organisms, to regulate its internal environment so as to maintain a stable condition, by means of multiple dynamic equilibrium adjustments controlled by interrelated regulation mechanisms. ... For sodium in the diet, see Edible salt. ... General Name, symbol, number potassium, K, 19 Chemical series alkali metals Group, period, block 1, 4, s Appearance silvery white Standard atomic weight 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 any references or sources. ... A representation of the 3D structure of myoglobin, showing coloured alpha helices. ... For other uses, see Viscosity (disambiguation). ... 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][7][9]

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. ... For transport in plants, see Vascular tissue. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... In medicine, a stoma (Greek - plr. ... For other uses, see Burn. ... 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), more commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ... Cardiac arrhythmia is any of a group of conditions in which the electrical activity 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 Pseudomonas aeruginosa bacteria (pink-red rods). ... E. coli redirects here. ... Binomial name Klebsiella pneumoniae (Schroeter 1886) Trevisan 1887 Klebsiella pneumoniae is a Gram-negative, nonmotile, encapsulated, lactose-fermenting, facultatively anaerobic, rod-shaped bacterium found in the normal flora of the mouth, skin, and intestines. ... Endotoxins are potentially toxic, natural compounds found inside pathogens such as bacteria. ... Gram-positive bacteria are those that are stained dark blue or violet by gram staining, in contrast to gram-negative bacteria, which are not affected by the stain. ... Binomial name Streptococcus pneumoniae Streptococcus pneumoniae is a species of Streptococcus that is a major human pathogen. ... Species S. pneumoniae S. pyogenes S. viridans Streptococcus is a genus of spherical, Gram-positive bacteria of the phylum Firmicutes. ... Anaphylaxis is a severe and rapid systemic allergic reaction to a trigger substance, called an allergen. ... Anaphylaxis is an acute systemic (multi-system) and severe Type I Hypersensitivity allergic reaction in humans and other mammals. ... An allergen is any substance (antigen), most often eaten or inhaled, that is recognized by the immune system and causes an allergic reaction. ... For the server security software, see Microsoft Forefront. ... For other meanings, see Drug (disambiguation). ... This article or section does not cite any 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... In 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. ... The Sympathetic Nervous System (SNS) is a branch of the autonomic nervous system. ... 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. ... Human respiratory system 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 (CO) is the volume of blood being pumped by the heart, in particular by 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 (in the adrenal gland). ...

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 vasoconstriction.
    • 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, 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:
  • Obstructive shock, similar to hypovolaemic shock but in addition:
  • Septic shock, similar to hypovolaemic shock except in the first stages:
  • Neurogenic shock, similar to hypovolaemic shock except in the skin's characteristics. In neurogenic shock, the skin is warm and dry.
  • Anaphylactic shock

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. ... The jugular veins are veins that bring deoxygenated blood from the head back to the heart via the superior vena cava. ... The jugular venous pressure (JVP, sometimes referred to as jugular venous pulse) is the indirectly observed pressure over the venous system. ... A cardiac arrhythmia, also called cardiac dysrhythmia, is a disturbance in the regular rhythm of the heartbeat. ... The jugular veins are veins that bring deoxygenated blood from the head back to the heart via the superior vena cava. ... In medicine, a pulsus paradoxus (PP), also paradoxic pulse and paradoxical pulse, is an exaggeration of the normal variation in the pulse during the inspiratory phase of respiration, in which the pulse becomes weaker as one inhales and stronger as one exhales. ... This article does not cite any references or sources. ... Cardiac output (CO) is the volume of blood being pumped by the heart, in particular by a ventricle in a minute. ... Sepsis (in Greek Σήψις, putrefaction) is a serious medical condition, resulting from the immune response to a severe infection. ... This page is about the condition called edema. ... Bronchospasm is a difficulty in breathing caused by a sudden constriction of the muscles in the walls of the bronchioles. ... This page is about the condition called edema. ...

Treatment

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

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


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. 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. ... This article is about human pneumonia. ... This article or section needs copy editing for grammar, style, cohesion, tone and/or spelling. ... mechanical or forced ventilation is the use of powered equipment, e. ... The Star of Life, a global symbol for medical service EMTs loading an injured skier into an ambulance An Emergency Medical Technician (EMT) is an emergency responder trained to provide emergency medical services to the critically ill and injured. ... For other uses, see Doctor. ...


The aim of these acts is to 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. ...


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. Hypovolaemia 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. ... For other uses, see Bleeding (disambiguation). ... Blood transfusion is the process of transferring blood or blood-based products from one person into the circulatory system of another. ... In physiology and medicine, hypovolemia is a state of decreased blood volume; more specifically, decrease in volume of blood plasma. ... In medicine, metabolic acidosis is a state in which the blood pH is low (under 7. ...


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%), or Hartmann's solution (Ringer's lactate). Dextrose solutions which contain free water are less effective at re-establishing circulating volume, and promote hyperglycaemia.
  • Colloids - For example, synthetic albumin (Dextran™), polygeline (Haemaccel™), succunylated gelatin (Gelofusine™) and hetastarch (Hepsan™). Colloids are, in general, much more expensive than crystalloid solutions and have not conclusively been shown to be of any benefit in the initial treatment of shock.
  • 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.

Vasoconstrictor agents have no role in the initial treatment of hemorrhagic shock, due to their relative inefficacy in the setting of acidosis, and due to the fact that the body, in the setting of hemorrhagic shock, is in an endogenously catecholaminergic state. Definitive care and control of the hemorrhage is absolutely necessary, and should not be delayed.


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 anti-shock 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. ... Military Anti-Shock Trousers are medical devices used to treat severe blood loss. ... 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. ... mechanical or forced ventilation is the use of powered equipment, e. ... It has been suggested that Artificial kidney be merged into this article or section. ... Anaphylaxis is an acute systemic (multi-system) and severe Type I Hypersensitivity allergic reaction in humans and other mammals. ... 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 consists 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] “Collapsed lung” redirects here. ... 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. ... Blood clot diagram. ... 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 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

  1. ^ a b c d e f g h i Irwin, Richard S.; Rippe, James M. (January 2003). Intensive Care Medicine. Lippincott Williams & Wilkins, Philadelphia & London. ISBN 0-7817-3548-3. 
  2. ^ a b c d e f Marino, Paul L. (September 2006). The ICU Book. Lippincott Williams & Wilkins, Philadelphia & London. ISBN 0-7817-4802-X. 
  3. ^ a b c d e f Fundamental Critical Care Support, A standardized curriculum of Critical Care. Society of Critical Care Medicine, Des Plaines, Illinois.
  4. ^ a b c d e f Harrison's Principles of Internal Medicine. 
  5. ^ Cecil Textbook of Medicine.
  6. ^ The Oxford Textbook of Medicine. 
  7. ^ a b Shock: An Overview PDF by Michael L. Cheatham, MD, Ernest F.J. Block, MD, Howard G. Smith, MD, John T. Promes, MD, Surgical Critical Care Service, Department of Surgical Education, Orlando Regional Medical Center Orlando, Florida
  8. ^ Armstrong, D.J. (2004). Shock. In: Alexander, M.F., Fawcett, J.N., Runciman, P.J. Nursing Practice. Hospital and Home. The Adult.(2nd edition): Edinburgh: Churchill Livingstone. 
  9. ^ Joynt, Gavin (April 2003). Introduction to management of shock for junior ICU trainees and medical students. The Chinese University of Hong Kong. Retrieved on 9 October, 2006.

PDF is an abbreviation with several meanings: Portable Document Format Post-doctoral fellowship Probability density function There also is an electronic design automation company named PDF Solutions. ... The Orlando Regional Medical Center (ORMC) is the only level I trauma center in the Central Florida area and, therefore, provides intensive care for this area. ... Nickname: Location in Orange County and the state of Florida Coordinates: , Country State Counties Orange Government  - Mayor Buddy Dyer (D) Area  - City 101 sq mi (261. ... is the 282nd day of the year (283rd in leap years) in the Gregorian calendar. ...

References

  • Armstrong, D.J. (2004) "Shock". In: Alexander, M.F., Fawcett, J.N., Runciman, P.J. Nursing Practice. Hospital and Home. The Adult.(2nd edition). Edinburgh: Churchill Livingstone.
  • 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, "Tolerance 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

is the 226th day of the year (227th in leap years) in the Gregorian calendar. ...

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