STATE OF SHOCK: SYMPTOMS, TYPES AND TREATMENT - MEDICINE - 2024

The shock is a condition in which there is not enough oxygen in the blood because blood pressure is very low. This causes organs and tissues to lack the oxygen they need, causing cells to die and waste to accumulate.

There are very different conditions that can cause the drop in blood pressure that, as a consequence, produces a state of shock. Some of them are decreased blood volume, malfunction of the sympathetic nervous system, hormonal alterations, allergies, etc. Depending on its causes, shock can be classified into different subtypes.

The word shock is used differently in the medical field and in the general public. It is popularly used to define an intense emotional reaction that arises when faced with stressful situations, such as receiving bad news.

In this case, shock refers to a loss of oxygen in the blood that results in symptoms such as increased heart rate, confusion, or fatigue.

Shock is a medical emergency that can cause serious injury, and even death. That is why it must be treated immediately.

Causes Why does the state of shock occur?

It is important to mention that it is essential for cells to have oxygen and glucose. This allows them to generate energy and do their job properly.

Oxygen enters the body through the lungs. From these the oxygen reaches the blood. Specifically, it is stored in red blood cells, binding to hemoglobin molecules. Red blood cells travel throughout the body thanks to the pumping of the heart, carrying oxygen to cells and tissues.

However, if the cells do not have oxygen, instead of using aerobic metabolism (with oxygen) they use anaerobic metabolism (without oxygen). This metabolism creates lactic acid as a by-product.

This causes the acid-base balance in the blood to change. That is, it becomes more acidic, beginning to release toxins that will affect the blood vessels.

Finally, anaerobic metabolism causes cells to die, which damages different tissues and organs.

Stages

There are three known stages of shock, each of which has different symptoms.

Stage I

In stage I (non-progressive), the body detects low blood flow and sets in motion certain mechanisms to counteract it.

Thus, the heart beats faster, the blood vessels reduce their diameter and the kidney tries to retain fluids. Shock does not have as many symptoms at this stage and prompt treatment can stop it.

Stage II

In stage II (progressive), the above mechanisms fail and identifiable symptoms begin to manifest. For example, the patient begins to feel confused by the lack of oxygen.

Stage III

In stage III (irreversible) the low pressure affects the tissues and organs, the heart begins to be damaged and the kidneys collapse. At this stage, serious damage occurs that could lead to death.

Symptoms of shock

The most common symptoms of shock are:

- Low blood pressure.

- Cold and clammy skin. The hands and feet may be pale or bluish in color.

- The affected person can breathe quickly and with difficulty.

- Acceleration of the heart rate.

- Nausea.

- vomiting

- Reduction of urine.

- Fatigue.

- Dilated pupils.

- Dry mouth.

- dizziness

- Anxiety.

- Irritability.

- Confusion and drowsiness.

- Altered mental state, with reduced alertness. It can progress to loss of consciousness.

Types

There are different types of shock depending on the cause that produces it:

Hypovolemic

It is characterized by a low volume of blood in the body. For a proper functioning of the body it is necessary that there are enough red blood cells. Also, there needs to be enough water in the blood so that fluids can move through the blood vessels. In fact, 90% of blood is water.

When there is dehydration, there may be enough red blood cells, although there is not enough blood volume. This causes the blood pressure to drop. Therefore, if there is less blood to pump, the heart must accelerate its rate to maintain production.

In the advanced stages of this type of shock, the patient cannot replace the amount of fluid lost, and the body cannot stabilize blood pressure.

It can also be due to internal bleeding (from a ruptured artery or damage to an organ) or external (for example, from a deep wound). This can also be called hemorrhagic shock.

Its most common causes are gastrointestinal bleeding and bleeding in the uterus in women. On the other hand, this state of shock is common in people with cancer.

This is because they are at higher risk of bleeding, as their liver does not allow proper clotting. People who take blood-thinning medications can also bleed excessively.

Other causes of hypovolemic shock can be dehydration, burns, heat stroke, vomiting or chronic diarrhea that can lead to a loss of blood volume, as well as a drop in blood pressure.

It is also associated with diseases that cause excess urination (urine). Some of them are diabetes insipidus and diabetes mellitus. This is because excessively high blood sugar causes excess water to be secreted in the urine.

Inflammation of the pancreas, kidney failure, or severe bleeding in the body can also lead to hypovolemic shock.

Cardiogenic

This occurs because the heart cannot adequately pump blood from the body. Its origin is linked to heart disease or heart attacks.

Neurogenic

This type of shock consists of a dysfunction of the sympathetic nervous system that reduces blood circulation through the body. It causes blood vessels to widen, causing blood to pool and blood pressure to drop.

Septic

This is generally produced by any type of bacteria, fungi, or virus (although to a lesser extent). When these infections are not treated properly, they lead to the appearance of certain toxins in the bloodstream.

As a consequence, the heart muscle may malfunction. As well as a widening of the diameter of the blood vessels, accompanied by severe arterial hypotension.

The toxins can damage the lungs, or cause acute respiratory failure. They can also cause kidney failure and liver failure.

Anaphylactic

It is a serious allergic reaction that causes a dilation of the blood vessels, leading to a drop in blood pressure.

Obstructive

This state of shock is caused by an obstruction of blood flow that may be due to cardiac tamponade. For example, compression of the heart by the accumulation of fluid in the pericardium (a tissue that surrounds the heart). Or, by embolism (blood clot in the arteries).

Endocrine

A serious hormonal disorder can cause the heart to malfunction, leading to a drop in blood pressure.

Treatment

It should be noted that shock is a medical emergency that needs immediate treatment. In the presence of symptoms, you should contact the emergency services as soon as possible.

First aid

First aid is essential to save the life of the patient. If the person is conscious, it is indicated to lie down and keep it comfortable and warm.

It is advisable to take his legs and raise them above the level of the torso and head. It is important not to move the person if you suspect spinal cord injuries or leg fractures.

If the patient is bleeding, you can try to temporarily control it by pressing a clean cloth to the wound. If the cloth gets soaked it must be replaced or replaced. It is important to keep the pressure in place constantly.

Even if the person is thirsty, it is recommended not to give them drinks or food. It is best to keep the patient calm and not moving.

Treatment for hypovolemic shock

Treatment of shock varies depending on the underlying causes, that is, the type of shock the person has experienced.

Thus, in hypovolemic shock, the blood volume may have to be increased by means of blood transfusions.

Treatment for cardiogenic shock

While, in cardiogenic shock, the indicated treatment is the application of drugs that narrow the blood vessels so that the heart can pump blood more easily. Blood volume can also be boosted by intravenous fluids.

Treatment for neurogenic shock

The treatment of neurogenic shock consists mainly in the administration of fluids into the veins and medications such as corticosteroids.

Treatment for sepetic shock

When it comes to septic shock, antibiotic treatment may be necessary to stop the infection.

Treatment for anaphylactic shock

On the other hand, anaphylactic shock requires the administration of medications such as antihistamines, corticosteroids, or adrenaline.

Treatment for obstructive shock

When obstructive shock occurs, the obstruction must be removed. This can be done by applying blood thinning medications to dissolve clots in the arteries.

Treatment for endocrine shock

Finally, in endocrine shock, drugs must be used to achieve hormonal balance. For example, if it is due to hypothyroidism, drugs should be prescribed to treat it.

References

1. A basic overview of shock. (2016, February 8). Retrieved from EMS1: ems1.com.
2. Cicetti, F. (April 26, 2013). What is Shock? Obtained from Livescience: livescience.com.
3. Medical Shock. (sf). Retrieved on April 24, 2017, from MedicineNet: medicinenet.com.
4. Shock (sf). Retrieved on April 24, 2017, from the University of Maryland Medical Center (UMMC): umm.edu.
5. Shock (sf). Retrieved on April 24, 2017, from Better Health Channel: betterhealth.vic.gov.au.
6. Shock (May 24, 2016). Obtained from Emedicine Health: emedicinehealth.com.