Shock

 

Shock

Definition

It is a condition characterized by a discrepancy between the circulating blood volume and the capacity of the vascular system,causing a reduction in the cardiac output and reduced blood supply to the heart,brain,kidneys,and liver.

 

 

Type	Causes
Hypovolemic	Severe external haemorrhage.        .Wounds due to accidents.        .Operative bleeding.        .Postabortal haemorrhage.        .Postpartum haemorrhage. .Severe internal haemorrhage.          .Peptic ulcer.          .Severe  haemoptysis.          .Rupture of an aneurysm. .Haemorrhagic disease. .Loss of plasma            .Burns >40%            .Peritonitis.            .Intestinal obstruction.             .Mesenteric venous thrombosis. .Dehydration and electrolyte imbalance.              .Severe diarrhea.               .Severe vomiting.                .gastroenteritis.
Anaphylactic	.Reaction to  drugs.               .Penicillin.               .streptomycin.               .Iron preprations. .Antiserum                .Antitetanus serum.                .Antigas gangrene serum. .Reaction to foods.
Cardiogenic	.Myocardial infraction. .Acute myocarditis. .Stokes –Adams’syndrome. .Rupture of a valve in the heart. .Rupture of a chordae tendinae in the heart. .Rupture of interventricular septum of the heart.
Septic	.Septicemia due to any cause. .Septic abortion. .diabetes mellitus. .cancer.
Vascular	.Obstruction in blood vessels causing interference with circulation of blood.
Endocrine	.Severe hypopituitarism. .Myxoedema. .Phenochromocytoma.
Neurogenic	.General anaesthesia. .Spinal anaesthesia. .Testicular trauma. .Wounds of pleura.
Psychological	.Unexpected bad news. .Sight of a bad accident.

 

Clinical features

1.Patient appears to be pale.

2.There is excessive sweating.

3.The blood pressure is low.

4.The pulse is rapid.

5.There is cyanosis.

6.The skin is cold.

7. There ar features of reduced blood supply to vital organs,as shown in the following table:-

 

Treatment

 

1.All patients in the ward are monitored carefully.

2.A patient likely to go into shock is observed carefully and at the earliest sign of development of shock, prophylactic measures are taken so as to prevent shock .thus a patient already admitted to the hospital is not allowed to go into shock.

3.The monitoring of the patient  is as shown in the following table:

Parameter	Frequency of monitoring
Temperature	Every half an hour.
Pulse	Every half an hour.
Respiration	Every half an hour.
Blood pressure	Every one hour.
Cyanosis	Every half an hour.
Level of consciousness	Every half an hour.
Urine output	Every one hour.
Intravenous infusion	Variable.

 

4.Intravenous fluids are infused  for the following indications:-

             .Severe burns.

             .Haemorhagic shock.

              .Hypovolemic shock.

              .Cardiogenic shock.

              .Septic shock.

5.The patient is kept in a warm bed with head low position.This position improves venous return to the heart, cardiac output, and perfusion of the vital organs.

6.The patient who is unconscious is kept in a prone position with his head turned to one side so that secretions by suction.

7.The mouth and pharynx are kept clean by removal of secretions by suction.

8.Artificial respiration is given if the respiration becomes slow or stops.

9.Oral hygiene is maintained every 4 hours.

10.Oxygen is given by nasal tube, nasal prongs,or face mask.

11.Morphine 15mg IMis given to relieve pain.

12.Acidosis is treated by administration of 100ml to 150 ml of 7.5% sodium bicarbonate IV.

13.Antibiotics are given for control of infection.

14.Vasopressors are given to increase the blood pressure.

15.Corticosteroids are given in anaphylactic shock.

16.Heparin is given for septic shock and haemolytic uremic shock.