Shock

Question 1

Define shock

Answer 1

Inadequate perfusion of body tissues due to acute failure of the cardiovascular system

Question 2

What are different types of shock?

Answer 2

• Septic shock
• Anaphylactic shock
• Neurogenic shock
• Hypovolaemic shock
• Cardiogenic shock

Question 3

What is septic shock?

Answer 3

• Systemic Inflammatory Response Syndrome (SIRS) (an exaggerated immune response) + infectious source
• This leads to widespread vasodilation causing a massive drop in BP

Question 4

What is anaphylactic shock?

Answer 4

• extreme Type I hypersensitivity reaction
• Similarly, results in distributive shock – widespread vasodilation due to inflammatorymediators, causing large BP drop

Question 5

What is neurogenic shock?

Answer 5

• spinal cord injury which results in impaired sympathetic function e.g.control over vascular tone -> again leads to distributive shock

Question 6

What is Hypovolaemic shock?

Answer 6

internal or external fluid loss from vessels -> reduced circulating volume, e.g. vomiting, diarrhoea, haemorrhage, pancreatitis

Question 7

What is cardiogenic shock?

Answer 7

• impairmentof cardiac output (pump failure)
• e.g: MI, Arrhythmia, Severe heart failure

Question 8

What are symptoms of shock?

Answer 8

• Typically associated with decreased CO and BP, as well as compensatory changes as a response

General symptoms include:
- Pale, cold skin – vasoconstriction to redirect blood flow to vital organs
- Sweating – sympathetic stimulation
- Rapid, weak pulse – tachycardia tries to compensate for CO drop (brady in neurogenic shock)
- Reduced pulse pressure
- Low SV -> low systolic BP
- Peripheral vasoconstriction ->
increases diastolic BP
- Rapid, shallow breathing – chemoreceptor-driven response due to build-up of PaCO2 (causing low blood pH)
- Reduced urine output – renal hypoperfusion and reduced glomerular filtration

Question 9

What are key diagnostic factors for shock?

Answer 9

As seen in signs/symptoms:
* - Hypotension
* - Tachycardia (brady in neurogenic)
* - Tachypnoea

• Obtundation (reduced alertness)
• Cold, clammy skin
• Mottled skin
• Focused history
• Identify cause of shock

There may be further/variable diagnostic factors,depending on the origin of the shock

Question 10

What might septic shock also present with?

Answer 10

fever &leukocytosis

Question 11

What might anaphylactic shock present with?

Answer 11

may present with typical Type 1 hypersensitivity symptoms urticaria,wheezing etc

Question 12

How do you manage shock?

Answer 12

• Stabilisation of airway (oxygen/ventilation if required)
• Vasopressors – to reverse vasodilation and increase BP (if needed)
• Fluid resuscitation- to restore BP (as long as not fluid overloaded)

Question 13

What might anaphylactic shock be treated with?

Answer 13

antihistamines/corticosteroids/epinephrine

Question 14

What might septic shock be treated with?

Answer 14

Abx

Question 15

What might cardiogenic shock be treated with?

Answer 15

• Tamponade – pericardiocentesis
• STEMI – PCI/thrombolytic therapy
• Arrhythmias (arrhythmia treatment)

Question 16

What might hypovolaemic shock be treated with?

Answer 16

due to haemorrhage will need bleeding management (should happen asap so they don’t bleed out)