Hypovolemic Shock
Answer. 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.
Description Of Different Types Of Shock
Classification of Shock
- Hypovolemic shock
- Cardiogenic shock
- Distributive shock:
- Septic shock
- Anaphylactic shock
- Neurogenic shock
- Obstructive shock
“Causes Of Hypovolemic Shock”
Hypovolemic shock
- It occurs due to loss of blood plasma or body flid and electrolytes, usually caused by massive hemorrhage,vomiting, diarrhea and dehydration.
- Hypovolemic shock is most common type of shock which is characterized by loss in circulatory volume which leads to decrease in venous return, decrease in filing of cardiac chambers, so there is decreased cardiac output which causes increase in systemic vascular resistance.
“Symptoms Of Cardiogenic Shock”
Hypovolemic shock Causes
Loss of extracellular fluid:
- Deviation of normal exchange pattern: As in vomiting, diarrhea, intestinal obstruction, peritonitis, and acute pancreatitis.
- Increased sweating without replacement in a non acclimatized individual.
- Third space shifts to sodium from extracellular to intracellular compartment due to failure of sodium pump caused by hypoxia.
Plasma loss: Due to burn.
Hemorrhage: Due to whole blood loss like.
- Surgical: During and following any major surgery especially cardiopulmonary bypass, pelvic surgery or major abdominal surgery.
- Traumatic: As a result of any type of major accident,warfare injuries, homicidal or following suicidal injury as by knife, bullet, etc.
- GI bleeding: Bleeding from peptic ulcer, perforation of intestine, bleeding from esophageal varices, etc.
- Obstructive bleeding: Incomplete abortion, placenta previa, etc.
“Best Ways To Treat Obstructive Shock”
Hypovolemic shock Clinical Features
- Anxiety, restless, excitation and disorientation.
- Pallor
- Thirst and hunger
- Cold and clammy skin
- Faint in upright position
- Tachycardia with rapid, thready pulse
- Hypotension
- Oligouria or anuria.
Hypovolemic shock Management
“What Tests Diagnose Obstructive Shock”
Cardiogenic shock
- Myocardial infection is the most common cause of cardiogenic shock.
- Cardiogenic shock occurs if more than 40% of left ventricle is involved in acute infection.
- Elevated cardiac chamber filing procedure is hallmark of cardiogenic shock.
Cardiogenic shock Clinical Features of Cardiogenic Shock
- The primary problem is decrease in contractility of heart,due to decrease contractility, there is decrease in stroke volume.
- Patient present with tachycardia, low blood pressure and decrease urinary output.
- Jugular venous pressure may be raised.
- Peripheries are cold and patient may be confuse or*moribund.
“Best Practices For Managing Shock Recovery In Icu”
Cardiogenic shock Treatment
- Proper oxygenation with intubation, ventilator support,cardiac version, pacing, antiarrhythmic drugs, correction of electrolytes, avoiding flid overload and prevention of pulmonary edema as immediate measures.
- Dobutamine is used to raise cardiac output provided there is adequate preload and intravascular volume. Dopamine is preferred in patients with hypotension.
- But it may increase peripheral resistance and heart rate worsening cardiac ischemia.
- Often both dopamine and dobutamine combination may be required.
- Careful judicial use of epinephrine. norepinephrine, phosphodiesterase inhibitors (amrinone, milrinone) are often needed.
- Anticoagulants and aspirin are given.
- Thrombolytics can be used β blockers, nitrates(nitroglycerine causes coronary arterial dilatation).
- ACE inhibitors are also used.
- Intra-aortic balloon pump: May need to be introduced;transfemorally as a mechanical circulatory support to raise cardiac output and coronary blood flow.
- Relief of pain, preserving of remaining myocardium and its function, maintaining adequate preload, oxygenation, minimizing sympathetic stimulation, correction of electrolytes should be the priorities.
- Percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft (CABG) are the fial choices.
“The Role Of Vasopressors In Treating Distributive Shock”
Distributive Shock
This occurs when the after load is excessively reduced.
Distributive shock occurs in following situations:
- Septic shock
- Anaphylactic shock
- Neurogenic shock
Septic shock
- This type of shock is mostly due to release of endotoxins in blood, which causes widespread vasodilation of blood vessels resulting in fall in the cardiac output.
- Fall in the cardiac output is not initial feature and vasoconstriction is not observed.
- Bacteria responsible for release of endotoxins are E. coli,Pseudomonas, Proteus, etc.
Septic shock Clinical features
- Restlessness, anxiety
- Cyanosis
- Cold and clammy skin
- Tachycardia
- Oligouria or anuria
- Acidotic breathing.
Septic Shock Management
- Sedation with diazepam
- IV fluids
- Blood culture and sensitivity
- Antimicrobial agents: Combination of penicillin or cephalosporins and aminoglycosides and metronidazole.
- Injection hydrocortisone
“Comprehensive Overview Of Shock Types And Their Differences”
Anaphylactic Shock
Anaphylactic shock can occur when a previously sensitized individual is exposed to a specifi antigen, IV drug, specially
penicillin, cephalosporins and iodinated contrast media are common offnders.
Anaphylactic Shock Clinical Features
- Due to reduced cerebral perfusion, there is change in mental status.
- Due to reduced preload and cardiac contractility, there is hypotension.
- Due to release of histamine and other chemical mediators there is urticaria.
- Due to hypoxia the cyanosis is caused.
- Due to anaerobic metabolism and hepatic dysfunction the lactic acidosis is caused.
- Due to coronary ischemia other dysrhythmias are caused.
Anaphylactic Shock Treatment
- Summon ambulance
- Always check whether respiratory distress is due to other causes.
- Assess the degree of cardiovascular collapse by checking pulse and blood pressure.
- Assess the degree of airway obstruction
- Stop administration of drug
- Patient should be kept supine
- Assess breathing diffilty by checking for stridor, wheeze
- Administer oxygen to patient by face mask
- Give antihistamine chlorpheniramine maleate 10 mg
- Administer hydrocortisone 20 mg
- Monitor consciousness, airway, breathing, circulation,pulse, blood pressure
- Raise legs if blood pressure is low
- Adrenaline 1:1000, 0.5 mL IM is given immediately.
- Repeat IM adrenaline every 5 minutes while waiting for ambulance
- Administer 100% oxygen
- CPR if cardiac arrest occurs
- If BP fall is rapid, 1:10,000 adrenalin may be infused IV slowly.
“Tips To Prevent Complications From Obstructive Shock”
Neurogenic Shock
- It occurs due to spinal cord injury which leads to dilatation of splanchnic vessels
- There will be bradycardia, hypotension, arrhythmias and decreased cardiac output.
Neurogenic Shock Clinical Features
- History of emotional stress or pain of a sudden nature.
- Bradycardia or pallor
- Tachypenea
- Fainting
- Reflexes are usually intact.
Neurogenic Shock Treatment
- Blood pressure should be controlled by giving vasoconstrictors.
- Oxygen is administered
- Hemodynamics should be maintained.
- Airways are cleared.
- Fluid therapy should be given
- Intravenous methylprednisolone therapy is done.
- Dopamine and phenylephrine can be used.
“Understanding The Causes Of Hypovolemic And Cardiogenic Shock”
Obstructive Shock
- The obstructive shock is due to cardiac temponade, due to tension pneumothorax and pulmonary embolus.
- In cardiac temponade, there is compression ofall chambers of heart with reduce cardiac output. The filing pressure of left- and right-sided chambers equalizes. The central venous pressure is high and the BP is low.
Obstructive Shock Treatment
- To maintain preload with flid or blood.
- Relief of obstructions, drain pericardial cavity as early as possible.
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