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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
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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
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activating the coagulation cascade.
contracting the bleeding vessels.
platelets are activated.
→ Formation of a blood clot.
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2- The cardiovascular system
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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
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↑ ADH secretion in → ↑ reabsorption of water
and salt
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Causes
Traumatic
Related
Vascular
Related
GI
Related
Pregnancy
Related
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Clinical Presentation
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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
Hemorrhagic
Shock
Traumatic
Shock
Surgical
Shock
Burn
Shock
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Treatment
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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
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The goals of pharmacotherapy are to reduce
morbidity and prevent complications.
Drug Category: Antisecretory agents
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These agents have vasoconstrictive
properties.
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Follow up
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Complications:
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Neurologic sequelae
Death
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Prognosis
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The prognosis is dependent on the degree of
volume loss.
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