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1.5: Shock

Table of Contents

Shock is a state of acute circulatory failure leading to decreased organ perfusion, with inadequate delivery of oxygenated blood to tissues and resultant end-organ dysfunction and it is an emergency condition. Adherence to evidence-based care of the specific causes of shock can enhance a patient’s chances of surviving7.

Diagnostic Criteria (Presentation of Shock)

  • Low blood pressure (systolic BP below 80 mmHg) is the key sign of shock
  • Weak and rapid pulse
  • Rapid and shallow breathing
  • Restlessness and altered mental state
  • Weakness
  • Low urine output

 

Table 1.1: Types of shock & Additional Symptoms

 

Type of shock Description Additional symptoms
Hypovolemic Most common type of shock

Primary cause is loss of fluid from circulation due to haemorrhage, burns, diarrhoea etc.

Weak thread pulse, cold and clammy skin.
Cardiogenic shock Caused by the failure of heart to pump effectively e.g. in myocardial infarction, cardiac failure etc. Distended neck veins, weak or absent pulses
Septic shock Caused by an overwhelming infection, leading to vasodilatation. Elevated body temperature
Neurogenic shock Caused by trauma to the spinal cord, resulting in sudden decrease in peripheral vascular resistance and hypotension. Warm and dry skin
Anaphylactic shock Caused by severe allergic reaction to an allergen, or drug. Bronchospasm,

angioedema and/or Urticaria

 

Investigations

The following investigations can be performed depending on the type of shock

  • Basic serum chemistry (including renal function)
  • Liver function tests
  • Blood culture
  • Ultrasound
  • Echocardiography
  • Lumbar puncture if a patient is suspected with meningitis

 

 

Non-Pharmacological Treatment

Prompt diagnosis of underlying cause is essential to ensure optimal treatment.

  • Maintain open airway
  • Administer oxygen with face mask and if needed after intubation with assisted ventilation
  • Check for and manage hypoglycemia

 

Pharmacological Treatment

Treatment depends on the type of shock. Intravenous fluid therapy is important in the treatment of all types of shock except for cardiogenic shock.

 

Adults: 

A: 0.9% Sodium chloride given as the 1L bolus infusion. Repeat bolus until blood pressure is improved. Transfuse blood and plasma expanders (-) in hemorrhagic shock

 

Children:

A: 0.9% Sodium chloride 20 mol/kg as a slow infusion.

 

Note

Do not administer IV fluids in case of cardiogenic shock but maintain IV line
If patient develops respiratory distress, discontinue fluids but maintain IV line
Septicemia in children: All children with shock which is not obviously due to trauma or simple watery diarrhea should receive antibiotic cover for probable septicemia. Give ceftriaxone, IM, 50–80 mg/kg/dose immediately as a single dose.

 

CAUTION !

Do not administer calcium containing fluids, e.g. Ringer Lactate, within 48 hours of administering ceftriaxone
Contra-indicated in neonatal jaundice
Annotate dose and route of administration on referral letter.

The codes will be shown below

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First: 170598
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Second: 180198

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