Shock: An Overview

Introduction

Shock is a serious condition caused by a sudden decline in the blood flow, causing the cells and organs to inadequately function as they do not get enough oxygen and nutrients- resulting in organ damage. It is a life-threatening condition requiring immediate medical attention.

What Is Shock?

The term shock has two categories- psychologic and physiologic shock.

• Psychogenic Shock: It is followed by a traumatic event and is referred to as an acute stress disorder.

• Physiologic Shock: It is a critical condition brought on by the sudden decrease in blood flow through the body. Causative agents could be trauma, heatstroke, blood loss, or an allergic reaction.

What Are the Signs and Symptoms of Shock?

Depending on the specific cause and type of shock, one may encounter one or more of the following:

• Change in pulse, making it rapid, weak, or absent pulse.

• Low blood pressure.

• Irregular heartbeat.

• Irregular breathing.

• Light-headed.

• Enlarged pupils.

• Lackluster eyes.

• Chest pain.

• Confusion.

• Palpitations.

• Decrease in urine.

• Thirst and dry mouth.

• Low blood glucose.

• Loss of consciousness.

• Vomiting.

• Agitation/restlessness.

• Discoloration of lips and fingertips.

• Excessive sweating makes skin moist and clammy.

What Causes Shock?

It can be caused by any sudden trauma or prevailing condition that affects the blood flow through the body. Shock can result in multiple organ damage with severe complications.

Shock can occur as a result of reduced blood flow, which can be caused by

Low blood volume (seen in heavy bleeding or dehydration).

• Changes in blood vessels (infection and allergic reactions).

• Certain medicines are used to treat heart function or blood pressure.

• Significant blood loss (trauma).

• Heart failure and problems.

• Blood infections or sepsis.

• Poisoning.

• Burns.

Shock is also associated with major bleeding disorders, congenital and acquired. A spinal cord injury is a form of neurogenic shock. Toxic shock syndrome is a type of shock from a foreign body invasion.

What Are the Types of Shock?

Some main types of shock include:

• Obstructive Shock- Occurs when blood gets obstructed and does not reach its destination, such as a pulmonary embolism. Congestion due to air or fluid can cause:

  • Pneumothorax (lung puncture).

  • Hemothorax (blood pooling in the space between the chest wall and lung).

  • Cardiac tamponade (fluid pooling is seen between the heart and the muscle).

• Cardiogenic Shock- Injury to the heart tissues can affect the blood flow to the body, leading to cardiogenic shock. Common causes of cardiogenic shock include:

  • Damage to the heart muscle.

  • Irregular heart rhythm.

  • Poor heart rhythm.

• Distributive Shock- If the blood vessels lose their tonicity, they can become flaccid, and not enough pressure builds up to pump the organs. Distributive shock can result in symptoms including redding, drop-in blood pressure, and fainting. Drug poisoning and brain injuries can also cause distributive shock.

The types of distributive shock:

• Anaphylactic Shock- This is an aggravation of the body’s immune response to an allergic reaction called anaphylaxis (allergic reactions that occur when the body cannot recognize safe substances). Anaphylaxis is triggered by allergic reactions to food, insect venom, or medications.

• Septic Shock- Sepsis, or blood poisoning, is a condition caused by infections caused by bacteria entering the bloodstream, resulting in damage to tissues or organs in the body.

• Neurogenic Shock- This results from an imbalance in the central nervous system, such as a spinal cord injury due to trauma. It causes an enlargement of the blood vessels, and the skin may feel warm and appear red. Whereas the heart rate drops, and blood pressure becomes low.

• Hypovolemic Shock- Hypovolemic shock happens due to a lack of blood in the blood vessels. The blood delivers oxygen and nutrients vital to the organs. If too much blood is lost, the organs lose functionality and collapse. Severe dehydration can form.

How Is Shock Diagnosed?

Doctors often detect shock by its external symptoms. They may also check for:

• Dropping blood pressure.

• Shallow pulse.

• Heartbeat.

Once the patients have been diagnosed with shock, the doctors start life-saving treatment to get the blood circulating through the body as quickly as possible. They may suggest fluids, drugs, blood products, and supportive care.

Imaging Tests- The doctor may order tests to ensure the damage to the internal tissues and organs, such as:

• Bone fractures.

• Organ ruptures.

• Muscle or tendon tears.

• Abnormal growths.

Such tests include:

• Ultrasound.

• X-ray.

• CT scan.

• MRI scan.

Blood Tests- The doctor may use blood tests to look for signs of:

• Significant blood loss.

• Infection in the blood.

• Drug or medication overdose.

How Is Shock Treated?

Shock can lead to loss of consciousness, breathing obstructions, and even heart failure:

• If any signs or symptoms of shock arise, reach out for help immediately.

• If the symptoms are observed in someone else, provide first aid treatment and call for professional help.

How to Manage a Person With Shock?

Managing shock is critical and of utmost importance:

• Call the medical emergency number immediately.

• Check for active bleeding or blockage in a person's airway, breathing, and circulation.

• Keep a check on the rate of breathing every five minutes intervals.

• If there is no injury to the head or another body part, and the person is conscious, gently place the person in the shock position. That is, put the person on his back and elevate the legs about 30 degrees (12 inches). Do not raise. Keep the head raised.

• Try to find any first aid for application to any wounds or injuries.

• Free the tight clothing.

If the person vomits or saliva pools up-

• Turn the head to one side to avoid choking. Keep the person in this position only when the spine is not injured.

• Do not give the person anything to eat or drink.

• Do not move the person.

Can Shock Be Fully Recovered ?

It is possible to recover from shock in due course fully. But shock can lead to permanent organ damage, dysfunction, and even death if it is not eradicated quickly. The recovery and long-term outlook depend on many factors, including:

• The type and cause of shock.

• The duration of time when the shock took place.

• The extensions of organ damage that you sustained during shock.

• The first-hand treatment and care (if any) received when under shock.

• The age and medical history.

Can Shock Be Prevented?

Some forms of shock are preventable. Aim for a stress-free, safe and sound life.

• If a history of severe allergies is present, avoid triggers, and carry an anti-allergic prescribed drug for an anaphylactic reaction.

• To avoid injuries, always wear protective gear while riding a bike. In addition, wear a seatbelt while driving or traveling.

• To lower the chances of heart damage, take a well-balanced diet, exercise regularly, and avoid smoking and drinking alcohol.

• Stay hydrated, especially in hot or humid conditions.

Conclusion

Shock is a clinical symptom of circulatory failure and requires an accurate diagnosis and a thorough understanding of the underlying root cause. Therefore, awareness of diagnosis and appropriate treatment in due course is vital as they can be crucial in preventing the progression of shock leading to organ damage. Treatment includes hemodynamic (study of blood flow) stabilization and correction of underlying etiology of shock.