Shock is a condition in which the systemic blood pressure is inadequate to supply oxygen and nutrients to support vital organs.

Classification

• 1. Hypovolemic shock
• 2. Cardiogenic Shock
• 3. Circulatory/Distributive Shock
• 4. Obstructive Shock

1. Hypovolemic shock: It is the most common and is characterized by decreased intravascular volume.

Clinical Manifestations.

• 1. Dizziness 
• 2. Loss of consciousness  
• 3. Renal failure  
• 4. Cold skin  
• 5. Headache 
• 6. Fatigue
•   7. Nausea 
• 8. Profuse sweating  
• 9. Pale skin  
• 10. Oliguria/Anuria  
• 11. Weak pulse

Pathophysiology.

Management : Goal

• Restore intravascular volume
• Redistribute fluid volume
• Correct underlying cause of fluid loss as soon as possible

1. Treat for cause e.g haemorrhage, dehydration, vomiting and diarrhoea
2. Fluid and blood replacement (Fluid resuscitation e.g Normal saline, Lactate Ringers,Colloids).
3. Redistribution of fluid: position patient in a modified Trendelenburg position with leg elevated at 20° and head slightly elevated.
4. Pharmacologic: To reserve the cause e.g antidiarrheal.
5. Observation: Monitor vital signs for transfusion reaction, dehydration and for side effects of the drug.
6. Monitor intake and output.
7. Copious fluid as tolorated.

2. Cardiogenic Shock: Occurs when the heart loses its ability to contract and pump blood thus impairing supply of blood to the heart tissues.

Causes

• Coronary cardiogenic Shock: Due to destruction of left ventricular myocardium
• Non Coronary Cause: Due to severe metabolic problems and tension.

Clinical Manifestations

• Angina pain
• Dysrhythmia
• Rapid breathing
• Tachycardia
• Weak pulse
• Hypotension
• Cold skin
• Oliguria/Anuria

Management of Cardiogenic Shock: Goal -: a) . Limit further myocardial damage and preserve healthy myocardium. 2.) Improve cardiac function but improving contractility.

1. Correction of underlying cause
2. Initiation of first line of treatment: supply supplemental oxygen (2-6L/min),pain management,
3. Pharmacotherapy: sympatomimethic agents, vasodilators, antiarrhythmic medications.
4. Fluid therapy: monitor for signs of fluid overload.
5. Mechanical assistive devices.
6. Give Intranasal oxygen if level is low
7. Bed rest
8. Position in Trendelenburg
9. Haemodynamic monitoring
10. Close observation

3. Distributive or circulatory shock: It occurs when blood volume is abnormally displaced in the vasculature. This Leads to hypovolemia due to inadequate supply of blood to the heart thus leading to inadequate tissue perfusion.

Classification of Distributive Shock

1. Septic Shock: it is the most commonest type of circulatory shock and is caused by infection. Risk factors : invasive procedures,age(<1yr and >65urs), malnourishment, immunosuppression. Signs and symptoms: Fever, tachycardia, naseau and vomiting, diarrhoea, agitation, tachypnea.
2. Neurogenic shock: In neurogenic shock vasodilatation of course due to lack of sympathetic tone. Causes: spinal cord injury,spinal anesthesia,nerve damage. Signs and symptoms: Dry skin,Warm skin, bradycardia.
3. Anaphylactic Shock: this is caused by a severe allergic reaction usually in patients who has already produced antibodies to a substance thus a systemic antigen antibody reaction.

STAGES OF SHOCK

• COMPENSATORY STAGE
• PROGRESSIVE STAGE
• IRREVERSIBLE STAGE