Types of Shock in Medicine

Types of Shock

• Five main types of shock: Hypovolaemic, Distributive, Cardiogenic, Obstructive, and Dissociative.

Hypovolaemic Shock

• Occurs due to acute loss of circulating blood volume.
• Common causes include:
  • Severe haemorrhage (internal or external).
  • Extensive burns leading to serum loss.
  • Severe diarrhoea and vomiting, resulting in loss of water and electrolytes.

Distributive Shock

• Characterized by widespread dilation of the peripheral vascular system, creating a larger container for the same blood volume.
• Causes leaky blood vessels in conditions such as sepsis and anaphylaxis, allowing fluid to shift into interstitial spaces.
• Common causes include:
  • Anaphylaxis.
  • Sepsis.
  • Spinal cord injury.

Cardiogenic Shock

• Results from the heart's inability to provide enough blood to meet metabolic needs.
• Commonly follows myocardial infarction, acute heart failure, or arrhythmia.

Obstructive Shock

• An uncommon type caused by blockages in blood flow to/from the heart.
• Common causes include:
  • Tension pneumothorax.
  • Cardiac tamponade.
  • Pulmonary embolism.

Dissociative Shock

• Occurs when the oxygen-carrying capacity of blood is compromised, often due to a low number of red blood cells or the presence of competing molecules.
• Causes include:
  • Anaemia.
  • Carbon monoxide poisoning.

Signs & Symptoms of Shock

• Tachycardia (increased pulse rate).
• Tachypnoea (increased respiratory rate or depth).
• Abnormal behavior, including agitation or confusion.
• Dizziness or faintness.
• Pale, cold extremities and delayed capillary refill.
• Signs of distress include sweating, dilated pupils, and thirst.
• Stage 4 indicates near-fatal state with reduced level of consciousness (LOC) and bradycardia.

Patient Variability in Shock Signs

• Some patients may not show abnormal vital signs until significant blood volume is lost (1,000ml-1,500ml).
• Groups at risk include young, athletic, healthy individuals, pregnant patients, and those on beta-blocker medication.

Management of Shock

• Use the acronym RABCD to manage shock:
  • Assess for time-critical factors.
  • Administer high-percentage oxygen.
  • Position conscious patients flat with head and shoulders slightly raised; consider raising lower limbs.
  • If unconscious, place in a stable side position.
• Treat other injuries and control bleeding.
• Avoid overheating or excessive cooling of the patient.
• Handle gently and provide constant reassurance and monitoring of vital signs (pulse, LOC, respiration).
• Keep the patient nil by mouth due to potential need for anaesthetic.
• Ensure timely transfer to appropriate medical facility and consider paramedic or medical assistance.

This quiz covers the five main types of shock: Hypovolaemic, Distributive, Cardiogenic, Obstructive, and Dissociative. Each type is explored in detail with a focus on causes, mechanisms, and clinical significance. Test your understanding of these critical medical conditions.