Shock

Shock

Occurs when cardiac output can not supply organs and tissues with adequate blood flow – a state of collapse of the cardiovascular system  leads to cellular dysfunction and organ failure. Multiple causes. Life threatening.

Occurs from internal or external haemorrhage or from pooling/stagnation of the blood flow.

Classification:
• Hypovolaemic (inadequate volume)– haemorrhagic (eg trauma); fluid depletion (eg dehydration; vomiting; thermal injury; trauma)
• Cardiogenic (inadequate myocardinal contraction)– myopathic (eg myocardial infarction; cardiomyopathy); mechanical (eg valvular failure); arrhythmic (eg tachycardia)
• Extracardiac obstructive – impaired diastolic filling (eg tension pneumothorax); impaired systolic contraction (eg acute pulmonary hypertension; aortic dissection)
• Distributive – septic (eg bacterial); toxic shock syndrome; anaphylactic; adrenal crisis

Clinical features:
Due to hypotension and inadequate tissue perfusion  pale, cool, clammy skin; thirst; rapid and shallow breathing; rapid and weak pulse; nausea and/or vomiting; evidence of loss of body fluids; collapse and unconsciousness.

Multiple organ dysfunction syndrome (MODS) – major cause of death in shock.

Immediate management:
Life threatening emergency. ABC’s; control any bleeding; if conscious  supine with legs elevated; if unconscious  stable side position with legs elevated; reassurance; maintain body temperature; call emergency services.

Subsequent management:
Admission to intensive care unit; haemodynamic support; restore perfusion; ECG monitoring; oxygen; maintain urine output; treatment of cause