What is shock?What are the cause,sign, symptoms and management of shock?

 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).

.