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Shock

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Shock

Shock refers to an abnormality of the circulatory system in which there is

inadequate tissue perfusion due to a relatively or absolutely inadequate cardiac

output.

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Hypovolemic shock Hypovolemic shock refers to a medical or

surgical condition in which rapid fluid loss results in multiple organ failure due to

inadequate circulating volume and subsequent inadequate perfusion. Most

often, hypovolemic shock is secondary to rapid blood loss (hemorrhagic shock).

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Pathophysiology

The human body responds to acute hemorrhage by activating the following major

physiologic systems: the hematologic, cardiovascular, renal, and neuroendocrine

systems.

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1- The hematologic system

activating the coagulation cascade. contracting the bleeding vessels. platelets are activated.

→ Formation of a blood clot.

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2- The cardiovascular system increasing the heart rate. increasing myocardial contractility. constricting peripheral blood vessels. redistributing blood to vital organs (brain,

heart, and kidneys) and away from skin, muscle, and GI tract.

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3- The renal system

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4- The neuroendocrine system ↑ ADH secretion in → ↑ reabsorption of water

and salt

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Causes

TraumaticRelated

VascularRelated

GI Related

Pregnancy Related

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Clinical Presentation

Hypotension. Rapid pulse. Cold, pale, clammy skin. Intense thirst. Rapid respiration. Restlessness. ↓ Urine volume.

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Do not rely on systolic BP as the main indicator of shock; this practice results in

delayed diagnosis. Compensatory mechanisms prevent a significant decrease in

systolic BP until the patient has lost 30% of the blood volume. More attention should be paid to the pulse, respiratory rate, and skin

perfusion. Also, patients taking beta-blockers may not present with tachycardia, regardless

of the degree of shock.

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Types of Hypovolemic

Shock

HemorrhagicShock

Traumatic Shock

SurgicalShock

BurnShock

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Treatment

Three goals exist in the emergency department treatment:(1) maximize oxygen delivery. (2) control further blood loss.(3) fluid resuscitation.

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Drug therapy

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

Drug Category: Antisecretory agents

These agents have vasoconstrictive properties.

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Follow up

Complications:

Neurologic sequelae Death

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Prognosis

The prognosis is dependent on the degree of volume loss.