SHOCKKEEPING IT SIMPLE

WHAT IS SHOCK?“A state of hypo-perfusion of organs due to circulatory failure”

TYPES OF SHOCK• Anaphylactic shock• Cardiogenic shock• Hypovolaemic shock• Neurogenic shock• Septic shock

ANAPHYLACTIC SHOCK• Type 1 IgE mediated reaction due to allergen• Mast cell degranulation• Histamine and prostaglandin release

• Dilated & permeable blood vessels• Hypotension• Release of leukotrienes

• Smooth muscle contraction

MEDICAL EMERGENCY• ABC• Adrenaline 0.5mg IM!!

• Repeat every 5 minutes if needed• Oxygen• IV access

• Hydrocortisone 200mg IV & Chlorphenamine 10mg IV• Fluids

NB • Measure tryptase• Monitor for 6-8 hours

CARDIOGENIC SHOCK• Hypo-perfusion of tissues due to cardiac dysfunction• HIGH mortality• Can occur acute or progressively• Causes include; MI, PE, arrhythmias, heart failure

MANAGEMENT OF CARDIOGENIC?• ABC• Oxygen• IV diamorphine (2.5-5mg)• Investigations

• ECG, U&Es, Cardiac enzymes, ABG, CxR, Echo• Close monitoring of

• CVP, BP, ABG, urine output *catheterize, ECG **hourly

HYPOVOLAEMIC SHOCK• Haemorrhage OR Fluid loss• Severe

• Blood loss of >2L• Tachycardia >140bpm• Low BP• Tachypnea/Respiratory collapse• Cold, mottled skin• Obtund• Anuria

MANAGEMENT• BP unrecordable? Call crash team!• ABC (high flow O2)• IV access x 2• FLUIDS FAST

• (Blood if blood loss)• Treat underlying cause• Ring for help

NEUROGENIC SHOCK• Disruption of autonomic pathways within spinal cord• E.g. post-spinal surgery/blunt trauma• Loss of stimuli for blood vessels

Dilate & reduce vascular resistanceHypotension

• Management • ABC• Oxygen • Fluids• Vasopressors/inotropes if required.

SEPTIC SHOCK• Endotoxin induced vasodilatation• Fever• ABC, oxygen• IV antibiotics within 1hour (blood cultures before if possible)• Refer to ITU

REFERENCESOxford Handbook of Clinical MedicineGoogle ImagesPersonal notes