SHOCK

Definition (Dorland’s pocket medical dictionary 28th edition):

1.a sudden disturbance of mental equilibrium
2.a profound hemodynamic and metabolic disturbance due to failure of the circulatory system to maintain adequate perfusion of vital
organs

Mechanism:

Types:

1.Cardiogenic Shock
It is defined as persistent hypotension and tissue
hypoperfusion caused by cardiac dysfunction in the
presence of adequate intravascular volume and left
ventricular filling pressure (inability of the heart to pump
adequate blood to tissues and end organs). Pathologic
conditions that reduce contractility, impair diastolic filling, or
cause obstruction can lead to cardiogenic shock. The
decreased contractility can result from:
a) acute myocardial infarction (AMI), cardiomyopathy,
sepsis, myocarditis, dysrhythmias, metabolic
abnormalities, papillary muscle rupture
b) impaired diastolic filling related to arrhythmias
c) obstruction due to pulmonary embolism, cardiac
tamponade, valvular disorders, and wall rupture or
defects.

Clinical Manifestations:
Chest pain, dyspnea, faintness. Tachycardia, tachypnea,
hypotension, jugular venous distention, and low measured
cardiac output are hallmarks. Cyanosis; skin mottling; rapid,
faint, or irregular pulses; low urine output; and occasional
peripheral edema are additional signs and symptoms of end-
organ hypoperfusion, pulmonary edema, etc.
2.Hypovolemic Shock
Medical or surgical condition in which rapid fluid
loss results in multiple organ failure due to
inadequate perfusion. It is defined as approximately
1 Liter or 1/5 loss of circulating volume). Causes of
Hypovolemic Shock:
 Hemorrhage
 Laceration of a vein or artery
 Open wounds
 Upper/Lower GI Bleed
 Pnuemo/Hemothorax
 Saline or Combined Saline/Water Loss
 Gastrointestinal losses (vomiting, diarrhea)
 High Fever
 Excessive sweating
 Diuretics
 Third Spacing (Fluid shifts):
 Soft tissue trauma
 Sepsis
 Peritonitis (intestinal obstruction)
 Ascites (effusion & accumulation of serous fluid
in abdominal cavity)
 Burn injuries
 Other causes of hypovolemic shock include:
 Adrenal insufficiency
 Inadequate fluid administration (even if the patient clinically  Hypothermia
appears to be overloaded with fluid)  Hypocalcemia
 Inadequate ventilation or oxygenation

Symptoms
• Anxiety or agitation • Decreased or no urine output
• Cool, clammy skin • General weakness
• Confusion

3.Neurogenic Shock or Vasogenic Shock

widespread and massive vasodilation that results from an imbalance between parasympathetic and
sympathetic stimulation of vascular smooth muscle. The clinical hallmark of neurogenic shock is a very
low SVR, along with other indicators of excessive parasympathetic activity. Bradycardia is the most
obvious manifestation, especially in the early stages. Bradycardia may cease when compensatory
mechanisms, particularly an increase in sympathetic system activity, have been initiated. Neurogenic
shock causes fainting if blood pressure decreases to the point that cerebral metabolism is not sufficient
to support consciousness. By allowing the blood pressure to equalize from head to toe as the individual
becomes prone, fainting can actually prevent shock

4.Anaphylactic Shock
It is the outcome of a widespread hypersensitivity reaction known as anaphylaxis.

5.Septic Shock
Shock associated with overwhelming infecton, most commonly Gram negative bacteria, thought to
result from the actions of endotoxins and other products of the infectious agent that cause
sequestration of blood in capillaries and veins. Clinical manifestations of septic shock are persistent low arterial pressure, low SVR
from vasodilation, and an alteration in oxygen extraction by all cells. Septic shock and states of prolonged shock causing tissue
hypoxia with lactic acidosis increase nitric oxide synthesis, activate ATP-sensitive and calcium-regulated potassium channels (KATP
and Kca, respectively) in vascular smooth muscle, and lead to depletion of ADH (vasopressin). Tachycardia causes cardiac output to
remain normal or become elevated, although myocardial contractility is reduced. Temperature instability is present, ranging from
hyperthermia to hypothermia. Effects on other organ systems may result in deranged renal function, gastrointestinal mucosa changes
that result in release of bacteria from the gut, jaundice, clotting abnormalities, deterioration of mental status, and tachypnea that often
progresses to ARDS.
ATOPY
A genetic predisposition toward the development of immediate hypersensitivity reactions against common environmental antigens.
Atopic individuals may or may not have symptoms of allergy, but are genetically predisposed to develop one or more ADs (i.e., allergic
rhinitis [AR], hayfever, asthma, atopic eczema and certain food allergies) and have a strong familial basis. These individuals may
produce IgE antibodies against otherwise harmless environmental substances.