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Shock

Shock

The word shock is used differently by the medical community and the general public. The connotation by the public is an intense emotional reaction to a stressful situation or piece of news. Its medical meaning is much different.

 

Medically, shock is defined as a condition where the tissues in the body don't receive enough oxygen and nutrients to allow the cells to function. This ultimately leads to cellular death, progressing to organ failure and finally, to whole body failure and death.

 

Shock often accompanies severe injury or illness. Medical shock is a medical emergency and can lead to other conditions such as lack of oxygen in the body's tissues (hypoxia), heart attack (cardiac arrest) or organ damage. It requires immediate treatment as symptoms can worsen rapidly.

 

Medical shock is different than emotional, or psychological, shock that can occur following a traumatic or frightening emotional event.

Symptoms

Low blood pressure is the key sign of shock.

 

Symptoms of all types of shock include:

 

  • Rapid, shallow breathing.
  • Cold, clammy skin.
  • Rapid, weak pulse.
  • Dizziness or fainting.
  • Weakness.

 

Depending on the type of shock the following symptoms may also be observed:

 

  • Eyes appear to stare.
  • Anxiety or agitation.
  • Confusion or unresponsiveness.
  • Low or no urine output.
  • Bluish lips and fingernails.
  • Sweating.
  • Chest pain.

 

When should I seek medical care for shock?

 

If you suspect shock after an injury, even if the person seems alright, call 911 or get them to an emergency department immediately. Prompt treatment can save a person's life.

 

The sooner shock is treated, the better. When treated quickly there is less risk of damage to a person's vital organs.

Causes

There are several main causes of shock:

 

• Heart conditions (heart attack, heart failure).

• Heavy internal or external bleeding, such as from a serious injury.

Dehydration.

• Infection.

• Severe allergic reaction.

• Spinal injuries.

Burns.

• Persistent vomiting or diarrhea.

 

Types of shock

 

Septic shock results from bacteria multiplying in the blood and releasing toxins. Common causes of this are pneumonia, intra-abdominal infections (such as a ruptured appendix) and meningitis.

 

Anaphylactic shock is a type of severe hypersensitivity or allergic reaction. Causes include allergy to insect stings, medicines or foods (nuts, berries, seafood) etc.

 

Cardiogenic shock happens when the heart is damaged and unable to supply sufficient blood to the body. This can be the end result of a heart attack or congestive heart failure.

 

Hypovolemic shock is caused by severe blood and fluid loss, such as from traumatic bodily injury, which makes the heart unable to pump enough blood to the body.

 

Neurogenic shock is caused by spinal cord injury, usually as a result of a traumatic accident or injury.

Treatment

Depending on the type or the cause of the shock, treatments will differ. In general, fluid resuscitation (giving a large amount of fluid to raise blood pressure quickly) with an IV in the ambulance or emergency room is the first-line treatment for all types of shock. The doctor will also administer medications such as epinephrine, norepinephrine or dopamine to the fluids to try to raise a patient's blood pressure to ensure blood flow to the vital organs.

 

Tests (for example, x-rays, blood tests, EKGs) will determine the underlying cause of the shock and uncover the severity of the patient's illness.

 

Septic shock is treated with prompt administration of antibiotics depending on the source and type of underlying infection. These patients are often dehydrated and require large amounts of fluids to increase and maintain blood pressure.

 

Anaphylactic shock is treated with diphenhydramine (Benadryl), epinephrine (an "Epi-pen"), steroid medications methylprednisolone (Solu-Medrol) and sometimes a H2-Blocker medication [for example, famotidine (Pepcid), cimetidine (Tagamet), etc.].

 

Cardiogenic shock is treated by identifying and treating the underlying cause. A patient with a heart attack may require a surgical procedure called a cardiac catheterization to unblock an artery. A patient with congestive heart failure may need medications to support and increase the force of the heart's beat. In severe or prolonged cases, a heart transplant may be the only treatment.

 

Hypovolemic shock is treated with fluids (saline) in minor cases, but may require multiple blood transfusions in severe cases. The underlying cause of the bleeding must also be identified and corrected.

 

Neurogenic shock is the most difficult to treat. Damage to the spinal cord is often irreversible and causes problems with the natural regulatory functions of the body. Besides fluids and monitoring, immobilization (keeping the spine from moving), anti-inflammatory medicine such as steroids, and sometimes surgery are the main parts of treatment.

 

Self-Care at Home

 

  • Call 911 for immediate medical attention any time a person has symptoms of shock. Do not wait for symptoms to worsen before calling for help. Stay with the person until help arrives. 
  • While waiting for help or on the way to the emergency room, check the person's airway, breathing and circulation (the ABCs). Administer CPR if you are trained. If the person is breathing on his or her own, continue to check breathing every five minutes until help arrives. 
  • Have the person lie down on his or her back with the feet elevated above the head (if raising the legs causes pain or injury, keep the person flat) to increase blood flow to vital organs. Do not raise the head.
  • Do NOT move a person who has a known or suspected spinal injury. 
  • Keep the person warm and comfortable. Loosen tight clothing and cover them with a blanket. 
  • Do not give fluids by mouth, even if the person complains of thirst. There is a choking risk in the event of sudden loss of consciousness.
  • Give appropriate first aid for any injuries.
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