What is shock?
Shock is a disorder that result from systemic hypoperfusion due to reduction either in cardiac output or in the effective circulating blood volume.
What are the causes of shock?
>Cardigenic shock:
•Intrensic factors: Miocardial Infraction, Arrythmias,Valvular heart diseases:sudden AR or MR, Myocarditis,Rupture of heart.
•Extrinsic factors : Acute massive pulmonary embolism, cardiac tamponade.
>Hypovolemic shock :Severe haemorrhage(about 1250 ml blood), Severe burn-loss of plasma, Severe diarrhoea-loss of fluid, severe vomiting -loss of fluid, others: Diabetic coma,Acute pancreatitis,Peritonitis,Acute poisoning.
>Septic shock :
•Gram-negative bacilli-E. Coli,Klebsiella pneumonia,Proteus species etc.
•Gram poaitive septicaemia
•Meningococcal septicaemia
•Fungal sepsis.
>Anaphylatic shock : Hypersensitivity reaction, Drugs : Penicillin, Cotromoxazole.
>Neurogenic shock : Anaestheaia, Spinal cord injury, Massive peripheral vasodialation.
≈ Symptoms :
•Sweating
•Pallor of skin
•Drowsness.
•Restlessness.
•Mental confusion.
•Unconsciousness.
≈Sign:
•Pulse:Rapid thready pulse (tachycardia)
•BP :Hypotension.
•Temperature : Cold and clammy skin.
•Respiration : rapid and shallow rispiration.
•Urine output : oliguria.
•Multiple organ failure.
Management of shocks
>>Assessment of the shocked patient
(Assessment should be done within few seconds).
1. Assessment of clinical appearance: sweating, pallor of skin, drowsiness, restlessness, mental
2. Assessment of vital signs: pulse, BP, temperature, respiratory rate & depth.confusion, unconsciousness.
3. State of dehydration.
4. Urine putput.
>>Maintenance of respiration
1. Airway clearance by oro-pharyngeal suction.
2. O2 inhalation (it should be given in all shocked patients).
3. Endo-tracheal tube (if needed).
>>Raising of foot end to increase cerebral circulation.
>>Maintenance of circulation:
1. Open/v channel & give /v fluid, e.g. 5% DNS or DA or N/S.
2. Blood transfusion (if needed).
>>Prevention of renal failure:
1. By keeping urine output above 50 ml/hour.
2. Diuretics (if needed).
3.Catheterization (if needed).
>>Correction of acidosis (if pH <7.2): by 7.5% sodium bicarbonate solution.
>>Specific treatment:
1. If cardiogenic shock:
Inj. Dopamine 2 amp+ 5% DA (500 ml) v stat 10
2. If hypovolemic shock : Due to diarrhoea - I/v cholera saline.
-ORS.
3.If septic shock:
• Broad spectrum antibiotics.
• Excision of dead tissue, drainage of pus or surgery for intra-abdominal sepsis (if needed).
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