Shock Symptoms And First Aid Treatment

Shock Symptoms And First Aid Treatment

Question. Write short answer on shock.

Answer.

Shock

Shock is defined as an acute clinical syndrome characterized by a significant, systemic reduction in tissue perfusion, resulting in decreased tissue oxygen delivery and insuffient removal of cellular metabolic products, resulting in tissue injury and severe dysfunction of vital organs.

It can occur either because the function of the heart itself is impaired, or because heart is inadequately filed.

Classification of Shock

Following is the classifiation of shock:

• Hypovolemic shock
• Cardiogenic shock
• Distributive shock:

• Septic shock
• Anaphylactic shock
• Neurogenic shock
• Obstructive shock.

“What are the symptoms of shock?”

Clinical Features

• Cold clammy skin, profuse sweating
• Hypotension (systolic BP <100 mmHg)
• Tachycardia with thready pulse
• Rapid, shallow respiration
• Restlessness, drowsiness, confusion
• Oliguria, may progress to anuria
• Jugular venous pressure elevated in cardiogenic shock,reduced in hypovolaemic and anaphylactic shock, variable in septic shock
• Multiorgan failure

Stages Of Shock

Stage l: Stage of compensatory shock—by neuroendocrine response to maintain the perfusion of the vital organs like brain,heart, kidney, liver.

“Case studies on shock outcomes and recovery”

Stage 2: Stage of decompensatory shock—where there is progressive shock causing persistent shock with severe hypotension (with mean arterial pressure <65 mm Hg); oliguria,tachycardia.

Stage 3: Stage of irreversible shock ­ with severe hypoxia and Multi organ dysfunction syndrome (MODS).

Causes Of Shock

Hypovolemic shock

Due to reduction in total blood volume. It may be due to:

Hemorrhage:

• External from wounds, open fractures
• Internal from injury to spleen, liver, mesentery or pelvis.
• Severe burns, which results in loss of plasma
• Peritonitis, intestinal obstruction
• Vomiting and diarrhea of any cause

“Understanding shock: Causes, symptoms, and treatment”

Cardiac causes:

• Acute myocardial infarction, acute carditis
• Acute pulmonary embolism wherein embolus blocks the pulmonary artery at bifurcation or one of the major branches
• Drug induced
• Toxemia of any causes
• Cardiac surgical conditions like valvular diseases,congenital heart diseases
• Cardiac compression causes:

• Cardiac tamponade due to collection of blood,pus, flid in the pericardial space which prevents the heart to expand leading to shock.
• Trauma to heart.

• Septic shock—is due to bacterial infections which release toxins leading to shock.
• Neurogenic shock—due to sudden anxious or painful stimuli causing severe splanchnic vessel vasodilatation.
  Here patient either goes for cardiac arrest and dies or recovers fully spontaneously—spinal cord injury/anaesthesia can cause neurogenic shock.
• Anaphylactic shock—is due to type I hypersensitivity reaction
• Respiratory causes:
• Atelectasis (collapse) of lung
• Thoracic injuries
• Tension pneumothorax
• Anesthetic complications.
• Other causes:
• Acute adrenal insuffiency (Addison’s disease)
• Myxedema

“How to recognize shock in an emergency situation”

Investigations and Monitoring of shock

• Regular monitoring with blood pressure, pulse, heart rate, respiratory rate, urine output measurement (hourly) should be done.
  Urine output should be more than 0.5 ml/kg/hour. Pulse oximetry should be used.
• Central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP—an accurate assessment of left ventricular/function) monitoring should be done.
  ICU care is needed during monitor period.
  But both CVP and PCWP are not accurate method of assessing tissue perfusion.
  Complete blood count, ESR, pH assessment, serum electrolyte estimation, chest X­ray (to rule out acute respiratory distress syndrome/pulmonary problems).

“Importance of early first aid for shock victims”

• Pus/urine/blood/bile/sputum cultures depending on the focus and need in sepsis.
• Serum lactate estimation is an important prognostic factor.
  Level >2 mEq/L suggest tissue ischemia.
• USG of a part, CT/MRI of the location of pathology of standard focus should be done; often may require repeti¬tion of these imaging to assess progress.
• Blood urea, serum creatinine, liver function tests,prothrombin time (PT), activated partial thromboplastin time (APTT), ECG monitoring are also should be done.
• All these tests including platelet count and arterial blood gas (ABG) should be repeated at regular intervals.

Treatment Of Shock

• Treat the cause, e.g. arrest hemorrhage, drain pus.
• Fluid replacement: Plasma, normal saline, dextrose,Ringer’s lactate, plasma expander (haemaccel).
  Dosage is maximum l liter can be given in 24 hours. Initially crystalloids then colloids are given.
  Blood transfusion is done whenever required.
• Ionotropic agents: Dopamine, dobutamine, adrenaline infusions—mainly in distributive shock like septic shock.
• Correction of acid­base balance: Acidosis is corrected by using 8.4% sodium bicarbonate intravenously.
• Steroid is often lifesaving. 500–l000 mg of hydrocortisone can be given.
  It improves the perfusion, reduces the capil¬lary leakage and systemic inflmmatory effcts.
• Antibiotics in patients with sepsis; proper control of blood sugar and ketosis in diabetic patients.
• Catheterization to measure urine output (30–50 mL/hour or > 0.5 mL/kg/hour should be maintained).

“Techniques for monitoring shock progression”

• Nasal oxygen to improve oxygenation or ventilator support with intensive care unit monitoring has to be done.
• Central venous pressure line to perfuse adequately and to monitor flid balance. Total parentral nutrition is given when required.
• Pulmonary capillary wedge pressure to monitor very critical patient.
• Hemodialysis may be necessary when kidneys are not functioning.
• Control pain—using morphine (4 mg IV).
• Ventilator and ICU/critical care management.
• Injection ranitidine IV or omeprazole IV or pantoprazole IV.
• Activated protein even though costly is benefiial as it prevents the release and action of inflmmatory response.
• MAST(Military Anti ­ shock Trouser ) provides circumferen¬tial external pressure of 40 mm Hg.
  lt is wrapped around lower limbs and abdomen, and inflted with required pres¬sure.
  It redistributes the existing blood and flid towards center. It should be deflted carefully and gradually.