Shock

Question 1

Define shock

Answer 1

A clinical condition characterised by a failure to adequately perfuse and oxygenate vital organs

Question 2

How is shock recognised clinically?

Answer 2

Hypotension: BP <90 systolic

Altered consciousness and fainting

Poor peripheral perfusion: cold, clammy, prolonged cap refill (although in septic shock there may be vasodilation at beginning)

Tachypnoea

Purpuric rash

Oliguria (<50ml/hr in adults)

Question 3

Classification of shock

Answer 3

1. Hypovolaemic: blood loss, fluid loss, redistribution (third spacing - blood moves into interstitium)
2. Cardiogenic:

Primary: MI, arrhythmias, valve dysfunction, myocarditis

Secondary: tamponade, massive PE, tension pneumothorax

3. Septic shock
4. Anaphylactic shock
5. Neurogenic shock: spine and spinal cord injury

*Important to note that the above classification gives the idea that these causes happen in unison but actually mixed aetiologies are common

Question 4

Management of shock

Answer 4

ABC

Venous access: take appropriate bloods

Give fluids where appropriate

Monitor urine output

Look for and treat cause

Inotropic and vasopressor therapy