Shock Overview

Shock is a critical condition characterized by decreased tissue perfusion, leading to organ failure and potential death.

Key Signs and Symptoms

• Low Blood Pressure: Classic sign for exams (think double S's - Shock = Severely low blood pressure).
• Organ Failure & Death: Caused by insufficient oxygen delivery to organs.

Four Stages of Shock

1. Initial Stage

   • Pathophysiology: Insufficient oxygen in blood leads to anaerobic metabolism.
   • Signs/Symptoms: Absent in this stage.

2. Compensatory Stage

   • Compensatory Mechanisms: Heart rate increases (tachycardia) and respiratory rate rises (tachypnea).
   • Nervous System: Activation of sympathetic nervous system and renin-angiotensin system to maintain blood pressure.

3. Progressive Stage

   • Key Sign: Cold, clammy skin (priority for exams).
   • Body's Response: Unable to compensate, indicating worsening condition.

4. Irreversible Stage

   • Outcome: Organ failure leading to death.

Types of Shock

1. Septic Shock

   • Cause: Widespread bloodborne infection (e.g., pneumonia, UTI).
   • Signs: Low blood pressure (<80 systolic), cool clammy skin, mental confusion, high WBC count, low body temperature in late stages.
   • Treatment: IV fluids, antibiotics.

2. Neurogenic Shock

   • Cause: Spinal cord injury (T6 or higher).
   • Signs: Bradycardia, hypotension, warm pink dry skin.
   • Intervention: IV normal saline to improve tissue perfusion.
   • Complication: Autonomic dysreflexia.

3. Hypovolemic Shock

   • Cause: Blood volume loss due to hemorrhage or excessive fluid loss (diarrhea, vomiting).
   • Signs: Hypotension, tachycardia, cold clammy skin.
   • Interventions: IV normal saline, lower head of the bed for blood flow.

4. Cardiogenic Shock

   • Cause: Heart failure (e.g., myocardial infarction).
   • Signs: Severe hypotension, weak heart pump.
   • Treatment: Dopamine and digoxin for inotropic support.

5. Anaphylactic Shock

   • Cause: Severe allergic reaction (e.g., bee sting, food allergies).
   • Treatment: Epinephrine (EpiPen), repeat Epi every 5-15 minutes if symptoms persist.
   • Signs: Hives, difficulty breathing, hypotension.

Key Treatment Points

• EpiPen Administration: Inject into outer thigh at 90° angle for 10 seconds; seek medical help immediately after use.
• Monitor Vital Signs: Signs of good perfusion include BP stabilization and capillary refill.
• Fluid Management: Maintain MAP >65 mmHg and CVP between 2-6 mmHg.
• Avoid Delays: Do not delay administering vasopressors; maintain flow rates for IV fluids to ensure effective outcomes.