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Circulatory shock: Difference between revisions
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'''Circulatory shock''', often called just '''shock''' is a hemodynamic disturbance which leads to inadequate oxygen supply to organs and tissues of the body. The ensuing tissue hypoxia causes metabolic disorder in the tissues leading to temporary or permanent disturbance of function, and in severe cases to [[necrosis]]. | <section begin="anaesthesia and intensive care" /><section begin="surgery" />'''Circulatory shock''', often called just '''shock''' is a hemodynamic disturbance which leads to inadequate oxygen supply to organs and tissues of the body. The ensuing tissue hypoxia causes metabolic disorder in the tissues leading to temporary or permanent disturbance of function, and in severe cases to [[necrosis]]. | ||
It’s a life-threatening condition which can develop as a complication of disease, procedure, or trauma. The most common form is septic shock, followed by cardiogenic and hypovolaemic. | It’s a life-threatening condition which can develop as a complication of disease, procedure, or trauma. The most common form is septic shock, followed by cardiogenic and hypovolaemic. Shock is an emergent state which requires emergency management. Treatment must be both supportive and, subsequently, targeted against the underlying cause. | ||
== Etiology and types == | == Etiology and types == | ||
=== Cardiogenic Shock === | === Cardiogenic Shock === | ||
Cardiogenic shock occurs due to cardiac dysfunction which leads to inadequate tissue perfusion despite adequate intravascular volume. | Cardiogenic shock is the most severe form of [[acute decompensated heart failure]] and occurs due to cardiac dysfunction which leads to inadequate tissue perfusion despite adequate intravascular volume. | ||
* Intrinsic (heart muscle insufficiency) | * Intrinsic (heart muscle insufficiency) | ||
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* Massive [[pulmonary embolism]] | * Massive [[pulmonary embolism]] | ||
* [[Tension pneumothorax]] | * [[Tension pneumothorax]] | ||
<section end="anaesthesia and intensive care" /><section end="traumatology" /> | |||
== Pathophysiology == | == Pathophysiology == | ||
See the corresponding pathophysiology 1 topics for rough details (although those details are not at all important for clinic). | See the corresponding pathophysiology 1 topics for rough details (although those details are not at all important for clinic). | ||
<section begin="anaesthesia and intensive care" /><section begin="traumatology" /> | |||
== Clinical features == | == Clinical features == | ||
Shock is characterised by features of decreased end-organ perfusion, including: | Shock is characterised by features of decreased end-organ perfusion, including: | ||
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* Hypovolaemic shock | * Hypovolaemic shock | ||
** Give balanced crystalloid, up to 3 L | ** Give balanced crystalloid, up to 3 L | ||
** If haemorrhagic -> give blood and colloid in 1:1 | ** If haemorrhagic -> give blood and colloid in 1:1 ratio | ||
** Treat underlying cause | ** Treat underlying cause | ||
* Neurogenic shock | * Neurogenic shock | ||
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** Intubation if airway is compromised ([[angioedema]]) | ** Intubation if airway is compromised ([[angioedema]]) | ||
** 0,5 mg [[epinephrine]] every 5 minutes | ** 0,5 mg [[epinephrine]] every 5 minutes | ||
** | ** [[Corticosteroid|Corticosteroids]], [[Antihistamine|antihistamines]] are also indicated but epinephrine is the most important acute treatment | ||
* Cardiogenic shock | * Cardiogenic shock | ||
** | ** Not too much fluids – may cause cardiogenic [[pulmonary oedema]] | ||
** [[Inotrope|Inotropes]] | ** [[Inotrope|Inotropes]] | ||
** [[Intra-aortic balloon pump]] | ** [[Intra-aortic balloon pump]] | ||
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* [[Disseminated intravascular coagulation]] | * [[Disseminated intravascular coagulation]] | ||
* Death | * Death | ||
< | <section end="anaesthesia and intensive care" /><section end="traumatology" /> | ||
[[Category:Traumatology]] | [[Category:Traumatology]] | ||
[[Category:Pathophysiology]] | [[Category:Pathophysiology]] | ||