SHOCK
SHOCK
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,
)
Heavy internal or external bleeding, such
as from a serious injury
Infection
Severe allergic reaction
Spinal injuries
Persistent
or
Types of shock:
Types of shock:
This is the most common type of shock and
based on insufficient circulating volume.
Its primary cause is loss of fluid from the
from either an internal or
external source. An internal source may be
. External causes may include
extensive bleeding or severe
.
Hipovolaemic shock
Signs and symptoms
Anxiety, restlessness,
Anxiety, restlessness,
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.
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
. Other causes of
cardiogenic shock include
,
(CHF),
or
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
.
.
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
.
Examples of this form of shock are
:
Septic shock
Anaphylactic shock
Neurogenic shock
Septic shock
Septic shock
- This is caused by an overwhelming
- This is caused by an overwhelming
, such as by
, such as by
bacteria i.e.
, Proteus
, Proteus
species,
species,
which release an
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.
cocci,
cocci,
such as
and
, 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
, due to
, due to
overwhelming bacterial infection.
overwhelming bacterial infection.
Vasodilation and increased
Vasodilation and increased
due to
due to
.
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.
edema
edema
, especially around
, especially around
the face.
the face.
Breathlessness and cough due to
Breathlessness and cough due to
narrowing of airways
narrowing of airways
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.