Lecture Notes: Shock

Definition and Importance

• Shock is a critical condition characterized by decreased tissue perfusion, leading to organ failure and death.
• Key Sign: Severely low blood pressure.
• Memory trick: Double 'S' for Shock and Severely low blood pressure.

Stages of Shock

1. Initial Stage:

   • Lack of oxygen in the blood leads to anaerobic metabolism.
   • Signs and symptoms are absent.

2. Compensatory Stage:

   • Body compensates for low oxygen.
   • Increased heart rate (tachycardia), increased respiratory rate (tachypnea).
   • Sympathetic nervous system activation.

3. Progressive Stage:

   • Key Sign: Cold and clammy skin.
   • Indicates worsening condition.

4. Irreversible Stage:

   • Leads to death.

Types of Shock

1. Septic Shock

   • Caused by widespread infection (bacterial, e.g., pneumonia or UTI).
   • Signs and Symptoms: Severe low blood pressure, cold clammy skin, mental confusion, high WBC count, fluctuating body temperatures.
   • Treatment: Emergency treatment including IV fluids and antibiotics.

2. Neurogenic Shock

   • Caused by spinal cord injury (T6 or higher).
   • Signs and Symptoms: Bradycardia, hypotension, warm pink and dry skin.
   • Intervention: IV normal saline to increase blood pressure.

3. Hypovolemic Shock

   • Caused by blood/fluid loss (e.g., trauma, diarrhea).
   • Key Signs: Cold clammy skin, hypotension, tachycardia.
   • Intervention: Lower head of bed, administer IV normal saline, then vasopressors.

4. Cardiogenic Shock

   • Caused by heart's inability to pump (e.g., heart attack).
   • Treatment: Dopamine and Digoxin to improve heart contraction.

5. Anaphylactic Shock

   • Severe allergic reaction.
   • Key Treatment: Epinephrine (EpiPen) injected into outer thigh.
   • Sequence: Epi first, then antihistamines (e.g., Benadryl), and albuterol.

Critical Interventions

• Septic Shock: Immediate reporting and treatment.
• Neurogenic Shock: Monitor for bradycardia, administer IV fluids.
• Hypovolemic Shock: Immediate fluid replacement and monitoring of central venous pressure.
• Cardiogenic Shock: Monitor for signs of heart failure, administer inotropic drugs.
• Anaphylactic Shock: Immediate administration of epinephrine, repeat as necessary.

Examination Tips

• Focus on key signs for each type of shock.
• Prioritize interventions based on severity and progression of symptoms.
• Remember specific treatments and interventions unique to each shock type.

Additional Points

• Vasopressors: Used after fluid replacement to maintain blood pressure.
• Central Venous Pressure (CVP): Key metric for monitoring fluid status.
• Education: Proper use and storage of EpiPens for anaphylactic shock.

These notes should serve as a comprehensive guide to understanding the critical elements of shock and its management. Focus on the progression of symptoms, key signs, and immediate interventions for each type of shock.