Medical shock

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Medical shock or shock is a medical emergency condition where the body lacks sufficient blood circulation. This deficiency of enough blood supplying body organs will lead to other life-threatening situations like insufficient oxygen in body tissues, heart attack, or organ damage.

It is typically accompanied by severe injury or illness. However, shock is the body's natural defense response to certain damage. Medical personnel often give immediate treatment as its symptoms may rapidly grow worse.

Contents

Types of medical shock

There are different types of medical shock. Here they are classified according to its cause:

  • Septic shock - This is due to bacteria that multiplied in the blood. These bacteria will release toxins in the bloodstream. This could be due to complication of pneumonia, intra-abdominal infections such as a ruptured appendix, or meningitis.
  • Anaphylactic shock - This is a severe and immediate type of allergic reaction. Hypersensitivity to insect stings, certain medications, or foods such as nuts, berries, or seafood can bring about this type of shock.
  • Cardiogenic shock - This happens when the heart is injured and is unable to pump enough blood to the body's circulation. It is often the consequence of a heart attack or congestive heart failure.
  • Hypovolemic shock - This results from grave blood and fluid loss, like from a severely traumatic body injury. The loss of fluids prevents the heart from pumping enough blood to the body.
  • Neurogenic shock - This is from damages to the spinal cord which may be because of a traumatic accident or injury.
  • Other types of shock - Distributive shock is caused by excessive widening of the blood vessels. Obstructive shock occurs when blood flow is stopped. It may be caused by cardiac tamponade or pulmonary embolism.

Causes

There are several causes of shock:

  • Infections that cause proliferation of bacterial toxins
  • Allergens that may trigger hypersensitivity reactions
  • Heart conditions like heart attack
  • Heavy bleeding, whether internal or external, due to serious trauma
  • Constant vomiting or diarrhea
  • Dehydration
  • Burns
  • Spinal injuries

Signs and symptoms

The initial sign for medical shock is very low blood pressure. Other symptoms that may appear due to shock may include:

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

Sometimes, these symptoms may also appear, but depends on the type of medical shock experienced.

  • Empty stare
  • Anxiety or agitation
  • Confusion or unresponsiveness
  • Low or no urine
  • Bluish lips or fingernails
  • Sweating
  • Chest pain

Diagnosis

People who are in shock rarely register blood pressure in a sphygmomanometer. Tests like chest x-rays, blood tests, and an electrocardiogram test will determine the cause of shock. These tests will also determine the severity of the affected person's illness. Meanwhile, an ultrasound, a CT scan or MRI scans may be used to check for internal bleeding.

Treatment

Generally, the first-line treatment is giving large amounts of intravenous fluids to raise blood volume. The rise of blood supply will eventually increase blood pressure. Sometimes, emergency personnel will give medications through these fluids to help raise the blood pressure. This increase in blood pressure will ensure that blood will flow to vital organs.

Oxygen is provided through ventilators to support respiration while blood volume is being increased. This also allows blood cells to carry oxygen to different tissues while the body is being treated for shock. The cause of shock will determine the type of treatment.

Septic shock is often treated through immediate administration of antibiotics. The type of antibiotics depends on the type of bacteria and the kind of infection. Antibiotics are usually given intravenously or sometimes given through the muscles.

Anaphylactic shock patients are given diphenhydramine, epinephrine, and steroid medications like methylprednisolone or H2-blokcers like famotidine. These help suppress the immune system and keep allergic reactions at a minimum.

Cardiogenic shock is treated by identifying and eventually treating its cause. Heart attack patients might require cardiac catherization to unblock a clogged blood vessel while patients with congestive heart failure may need additional medications to support and increase the heart's pumping force.

Hypovolemic shock is treated by giving fluids like normal saline or 5% dextrose solutions. Sometimes, blood transfusions are given in severe cases. Doctors will often seek and correct the source of fluid loss such as bleeding injuries.

Neurogenic shock is the most difficult case of medical shock as damages to the spine is irreversible and may cause problems with the body's regulatory functions. Main parts of the treatment, aside from giving fluids and monitoring, include immobilization of the spine, giving anti-inflammatory drugs like steroids and sometimes, surgery.

Distributive shock is treated by giving the patient vasoconstrictors to boost blood to vital organs and increase blood pressure. However, these are used for a short time as they might decrease blood supply to other tissues.

Prognosis

What happens to the person affected often depends on the following:

  • Cause and severity of shock
  • Age and general health
  • Promptness of treatment

Generally, both hypovolemic shock and anaphylactic shock have full recovery, especially if medical treatment is given immediately.

Septic shock is a deadly condition as it has a mortality rate of 40-75%. However, the sooner the infection is treated, the better the chances for success.

Cardiogenic shock has only 1/3 of sufferers survive. Spinal shock has the worst post-treatment outlook because there are currently few effective treatments for it.

In the Philippines

In a study done by UP-PGH in 1999, 24.8% of blood infected cases were identified. This produced a 77% mortality rate, with septic shock causing 42% of the deaths. The researchers also identified that 45% of these cases had the respiratory tract as the predominant site of infection. Most of the bacteria that were found to cause septic shock were Enterobacters and Staphylococcus aureus.

Hypovolemic shock is the most common cause of death of people in Southern Philippines suffering from dengue fever. Although the reported cases of dengue have gone down dramatically, reported deaths on dengue due to shock have also increased. Health agencies have formulated solutions and resolution to prevent the spread of such disease.

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