Clinical Shock Component 5

Types of Shock

• Hypovolaemic: Caused by acute loss of circulating blood volume.
• Distributive: Results from widespread dilation of peripheral vascular system.
• Cardiogenic: Occurs when the heart cannot circulate sufficient blood.
• Obstructive: Caused by interference in blood flow to/from the heart.
• Dissociative: Involves impaired oxygen carrying capacity of blood.

Hypovolaemic Shock

• Triggered by severe hemorrhage (internal/external) resulting in total blood volume loss.
• Can also stem from extensive burns leading to serum loss.
• Severe diarrhea or vomiting leads to loss of water and electrolytes.

Distributive Shock

• Blood vessels become 'leaky', allowing fluids to enter interstitial spaces.
• Common causes include anaphylaxis and sepsis.
• Can be associated with nerve-related issues, such as spinal cord injury.

Cardiogenic Shock

• Most frequently follows myocardial infarction, where heart function is compromised.
• Other causes include acute heart failure and arrhythmias.

Obstructive Shock

• Rare, caused by obstructions affecting blood flow such as:
  • Tension pneumothorax
  • Cardiac tamponade
  • Pulmonary embolism

Dissociative Shock

• Results from inadequate red blood cells to transport sufficient oxygen.
• Conditions include anemia and carbon monoxide poisoning.

Signs & Symptoms of Shock

• Tachycardia: Increased pulse rate.
• Tachypnoea: Elevated respiratory rate or depth.
• Abnormal behavior: May exhibit agitation or confusion.
• Physical signs: Dizziness, pale/cold extremities, delayed capillary refill.
• Severe symptoms in Stage 4: Reduced level of consciousness and bradycardia.

Noteworthy Observations

• Certain demographics, such as young and athletic individuals, pregnant patients, and those on beta blockers may not show abnormal vital signs until significant blood volume loss (1,000ml-1,500ml) occurs.

Management of Shock

• Follow the RABCDE protocol: Assess for time-critical situations.
• Administer high-concentration oxygen immediately.
• If conscious, position the patient flat with head and shoulders slightly raised and consider elevating the lower limbs.
• If unconscious, place the patient in a stable side position.
• Address other injuries and control bleeding.
• Maintain normal body temperature; avoid overheating or hypothermia.
• Handle gently and provide constant reassurance.
• Continuous monitoring of vital signs (pulse, consciousness, respiration) is essential.
• Do not give anything by mouth due to potential need for anesthesia.
• Ensure timely transfer to an appropriate medical facility and consider calling for paramedic assistance.

This quiz covers the types, causes, stages, and management of shock in clinical settings. It focuses on understanding the different forms of shock including hypovolemic, distributive, cardiogenic, obstructive, and dissociative. Test your knowledge and improve your clinical skills in recognizing and managing shock effectively.