A condition in which circulation fails to meet the nutritional needs of the cells and at the same time fails

to remove the metabolic waste products.

A Clinical syndrome that develops when Oxygen delivery is inadequate to meet metabolic requirements of the tissues due to some form of acute circulatory failure.

 Shock

left untreated may be fatal. It must be recognized and treated immediately, or the patient may die.

TYPES: 1.Hypovolemic 2.Septic 3. Cardiogenic 4.Traumatic

is an emergency condition in which severe blood and fluid loss makes the heart unable to pump enough blood to the body. This type of shock can cause many organs to stop working.
Losing about 1/5 or more of the normal amount of blood in your body causes hypovolemic shock.

Blood loss can be due to: Bleeding from cuts Bleeding from other injuries Internal bleeding, such as in the gastrointestinal tract The amount of circulating blood in your body may drop when you lose too many other body fluids, which can happen with: Burns Diarrhea Vomiting

Symptoms

Anxiety or agitation Cool, clammy skin Confusion Decreased or no urine output General weakness Pale skin color (pallor) Rapid breathing Sweating , moist skin Unconsciousness

 The

greater and more rapid the blood loss, the more severe the symptoms of shock.

Signs

and tests An examination shows signs of shock, including: Low blood pressure Low body temperature Rapid pulse Tests that may be done include: Complete blood count (CBC) CT scan or x-ray of suspected areas Endoscopy

Treatment
Get immediate medical help. In the meantime, follow these steps:

Keep the person comfortable and warm (to avoid hypothermia). Have the person lie flat with the feet lifted about 12 inches to increase circulation. However, if the person has a head, neck, back, or leg injury, do not change the person's position unless he or she is in immediate danger. Do not give fluids by mouth. If person is having an allergic reaction, treat the allergic reaction, if you know how. If the person must be carried, try to keep him or her flat, with the head down and feet lifted. Stabilize the head and neck before moving a person with a suspected spinal injury.

The goal of hospital treatment is to replace blood and fluids. An intravenous (IV) line will be put into the person's arm to allow blood or blood products to be given. Medicines such as dopamine, dobutamine, epinephrine, and norepinephrine may be needed to increase blood pressure and the amount of blood pumped out of the heart (cardiac output). Other methods that may be used to manage shock include: Heart monitoring, including Swan-Ganz catheterization Urinary catheter to collect and monitor how much urine is produced

Expectations (prognosis)
Hypovolemic shock is always a medical emergency. However, symptoms and outcomes can vary depending on:

Amount of blood volume lost

Rate of blood loss Ilness or injury causing the loss In general, patients with milder degrees of shock tend to do better than those with more severe shock. In cases of severe hypovolemic shock, death is possible even with immediate medical attention. The elderly are more likely to have poor outcomes from shock. Complications Kidney damage Brain damage

Prevention
Preventing shock is easier than trying to treat it once it happens. Quickly treating the cause will reduce the risk of developing severe shock. Early first aid can help control shock.

Definition

Cardiogenic shock is a state in which the heart has been damaged so much that it is unable to supply enough blood to the organs of the body.

Causes, incidence, and risk factors Shock occurs whenever the heart is unable to pump as much blood as the body needs.

The most common causes are serious heart complications. Many of these occur during or after a heart attack (myocardial infarction). These complications include: Dangerous heart rhythms, such as ventricular tachycardia, ventricular fibrillation, or supraventricular tachycardia Very slow heart rhythm (bradycardia) or heart conduction block Tear or rupture of the wall (septum) between the left and right ventricle Tear or rupture of the muscles or tendons that support the heart valves, especially the mitral valve

A large section of heart muscle that no longer moves well or does not move at all
Rupture of the heart muscle due to damage from the heart attack

Symptoms
Profuse sweating , moist skin

Rapid breathing Rapid pulse Restlessness , agitation , confusion Skin that feels cool to the touch Pale skin color or blotchy (mottled) skin Weak (thready) pulse

Decreased mental status

Loss of ability to concentrate Loss of alertness

Coma

Signs and tests

An examination will reveal: Low blood pressure (less than 90 systolic)

Blood pressure may drop more than 10 points when you stand up after lying down (orthostatic hypotension)
Weak (thready) pulse

Laboratory tests include: Arterial blood gas

Blood chemistry ( chem-7 , chem-20 , electrolytes , cardiac enzymes) CBC

Treatment Cardiogenic shock is a medical emergency. Treatment requires hospitalization. The goal of treatment is to save your life and treat the cause of shock.

Medications may be needed to increase blood pressure and heart function, including: Dopamine Dobutamine Epinephrine Norepinephrine When an arrhythmia is serious, urgent treatment may be needed to restore a normal heart rhythm. This may include:

Electrical "shock" therapy (defibrillation or cardioversion) Implanting a temporary pacemaker Medications given through a vein (intravenous) You may receive pain medicine if necessary. Bed rest is recommended to reduce demands on the heart. Getting oxygen lowers the workload of the heart by reducing tissue demands for blood flow. You may receive intravenous fluids, including blood and blood products, if needed.

When an arrhythmia is serious, urgent treatment may be needed to restore a normal heart rhythm. This may include:

Electrical "shock" therapy (defibrillation or cardioversion) Implanting a temporary pacemaker Medications given through a vein (intravenous) You may receive pain medicine if necessary. Bed rest is recommended to reduce demands on the heart. Getting oxygen lowers the workload of the heart by reducing tissue demands for blood flow. You may receive intravenous fluids, including blood and blood products, if needed.

Expectations (prognosis) In the past, the death rate from cardiogenic shock ranged from 80% - 90%. In more recent studies, this rate has improved to between 50% - 75%.

When cardiogenic shock is not treated, the outlook is not good.

Complications Brain damage Kidney damage Liver damage

Prevention You may reduce the risk by quickly and aggressively treating any related disorders.

Shock due to the severe allergic antigenantibody reaction to substances such as drugs, contrast media, blood products, or insect or animal venom is called anaphylactic shock. Food products such as seafood, nuts, peanuts, peanut butter, and MSG can also cause anaphylactic shock.

Causes, incidence, and risk factors:

Anaphylaxis is an severe, whole-body allergic reaction. After being exposed to a substance like bee sting venom, the person's immune system becomes sensitized to that allergen. On a later exposure, an allergic reaction may occur. This reaction is sudden, severe, and involves the whole body. Tissues in different parts of the body release histamine and other substances. This causes the airways to tighten and leads to other symptoms. Some drugs (polymyxin, morphine, x-ray dye, and others) may cause an anaphylactic-like reaction (anaphylactoid reaction) when people are first exposed to them. This is usually due to a toxic reaction, rather than the immune system response that occurs with "true" anaphylaxis.

Symptoms: Symptoms develop rapidly, often within seconds or minutes. They may include the following: Abdominal pain or cramping Abnormal (high-pitched) breathing sounds Anxiety Confusion Cough Diarrhea Difficulty breathing Fainting, light-headedness, dizziness Hives, itchiness Nasal congestion Nausea, vomiting Sensation of feeling the heart beat (palpitations) Skin redness Slurred speech Wheezing

Signs and tests:

Signs include: Abormal heart rhythm (arrhythmia) Fluid in the lungs (pulmonary edema) Hives Low blood pressure Mental confusion Rapid pulse Skin that is blue from lack of oxygen or pale from shock Swelling (angioedema) in the throat that may be severe enough to block the airway Swelling of the eyes or face Weakness Wheezing

Treatment:

Anaphylaxis is an emergency condition requiring immediate professional medical attention.

Check the ABCs (airway, breathing, and circulation from Basic Life Support) in all suspected anaphylactic reactions.

CPR should be started, if needed. People with known severe allergic reactions may carry an Epi-Pen or other allergy kit, and should be helped if necessary.
Paramedics or physicians may place a tube through the nose or mouth into the airways (endotracheal intubation) or perform emergency surgery to place a tube directly into the trachea (tracheostomy or cricothyrotomy). Epinephrine should be given by injection in the thigh muscle right away. This opens the airways and raises the blood pressure by tightening blood vessels. Treatment for shock includes fluids through a vein (intravenous) and medications that support the actions of the heart and circulatory system. The person may receive antihistamines, such as diphenhydramine, and corticosteroids, such as prednisone, to further reduce symptoms (after lifesaving measures and epinephrine are administered).

Expectations (prognosis): Anaphylaxis is a severe disorder that can be lifethreatening without prompt treatment. However, symptoms usually get better with the right therapy, so it is important to act right away. Complications: Airway blockage Cardiac arrest (no effective heartbeat) Respiratory arrest (no breathing) Shock

Prevention:
Avoid

known allergens. Any person experiencing an allergic reaction should be monitored, although monitoring may be done at home in mild cases. Occasionally, people who have a history of drug allergies may safely be given the medication they are allergic to after being pretreated with corticosteroids (prednisone) and antihistamines (diphenhydramine). People who have a history of allergy to insect bites/stings should carry (and use) an emergency kit containing injectable epinephrine and chewable antihistamine. They should also wear a MedicAlert or similar bracelet or necklace stating their allergy.

Definition Septic shock is a serious condition that occurs when an overwhelming infection leads to life threatening low blood pressure.

Causes, incidence, and risk factors Septic shock occurs most often in the very old and the very young. It also occurs in people who have other illnesses. Any type of bacteria can cause septic shock. Fungi and (rarely) viruses may also cause the condition.Toxins released by the bacteria or fungi may cause tissue damage, and may lead to low blood pressure and poor organ function. Some researchers think that blood clots in small arteries cause the lack ofblood flow and poor organ function.

The body also produces a strong inflammatory response to the toxins. This inflammation may contribute to organ damage.

Risk factors for septic shock include: Diabetes Diseases of the genitourinary system, biliary system, or intestinal system Diseases that weaken the immune system such as AIDS Indwelling catheters (those that remain in place for extended periods, especially intravenous lines and urinary catheters) Leukemia Long-term use of antibiotics Lymphoma Recent infection Recent surgery or medical procedure Recent use of steroid medicines

Symptoms Septic shock can affect any part of the body, including the heart, brain, kidneys, liver, and intestines. Symptoms may include:

Cool, pale extremities High or very low temperature, chills Lightheadedness Low blood pressure, especially when standing Low urine output Palpitations Rapid heart rate Restlessness, agitation, lethargy, or confusion Shortness of breath

Signs and tests Blood tests may be done to check for infection, low blood oxygen level, disturbances in the body's acid-base balance, or poor organ function or organ failure.

Treatment Septic shock is a medical emergency. Patients are usually admitted to the intensive care unit of the hospital. Treatment may include:

Breathing machine (mechanical ventilation) Drugs to treat low blood pressure, infection, or blood clotting Fluids given directly into a vein (intravenously) Oxygen Surgery There are new drugs that act against the extreme inflammatory response seen in septic shock. These may help limit organ damage. Hemodynamic monitoring -- the evaluation of the pressures in the heart and lungs -- may be required. This can only be done with special equipment and intensive care nursing.

 Expectations

(prognosis) Septic shock has a high death rate. The death rate depends on the cause of the infection, how many organs have failed, and how quickly and aggressively medical therapy is started. Complications Respiratory failure, cardiac failure, or any other organ failure can occur.

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