• Shock

    Definition

    Shock occurs when inadequate blood flow threatens the function of multiple organs. Shock is a potentially life-threatening condition. The sooner it is treated, the better the outcome. If you suspect someone is in shock, dial 911 immediately.

    Causes

    Some causes of shock include:
    • Congestive heart failure
    • Heart attack
    • Spinal cord injury
    • Sepsis (infection of the blood)
    • Other severe infection
    • Allergic reaction
    • Poisoning
    • Loss of blood volume (hypovolemia)—This can be from severe bleeding or severe dehydration.
    • Heatstroke
    • Trauma

    Risk Factors

    The following factors increase your chances of developing shock:
    • Pre-existing heart disease
    • Impaired immunity
    • Severe allergies

    Symptoms

    If you experience any of these, do not assume it is because of shock. These symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your doctor. The symptoms of shock depend on the cause.
    Symptoms may include:
    • Weakness
    • Altered mental status
    • Cool and clammy skin
    • Low blood pressure
    • Decreased urination
    • Weak and rapid pulse
    • Slow and shallow or rapid and deep breathing
    • Lackluster (dull) eyes
    • Dilated pupils
    Symptom of Shock
    Dilated and Constricted pupil
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    Diagnosis

    When you arrive at the hospital, your doctor will perform a physical exam.
    Tests may include the following:
    • Breathing assessment
    • Blood pressure measurement
    • Heart rate monitoring
    • Other tests, depending on the cause of shock

    Treatment

    Talk with your doctor about the best plan for you. Treatment options include the following:

    Breathing Resuscitation

    If you are having trouble breathing, your doctor will clear your airway. Oxygen and breathing assistance may be provided if you need it.

    Optimizing Blood Pressure and Heart Rate

    You may receive an IV and/or blood transfusions. These will stabilize your blood pressure and heart rate.
    Insertion of IV for Transfusion or Medications
    IV insertion
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    Medications

    You may be given vasopressor medications. These constrict your blood vessels to increase blood pressure. Drugs may also be used to increase your heart contractions.

    Prevention

    To help reduce your chances of getting shock, take the following steps:
    • Prevent or control heart disease.
    • Avoid activities that put you at risk of falls or other injuries.
    • Carry an epinephrine pen with you if you have a severe allergy.

    RESOURCES

    American College of Emergency Physicians http://www.acep.org/

    National Institutes of Health http://www.nih.gov/

    CANADIAN RESOURCES

    Canadian Association of Emergency Physicians http://caep.ca/

    Canadian Red Cross http://www.redcross.ca/

    References

    Goldman L, Ausiello D, eds. Cecil Textbook of Internal Medicine. 23rd ed. Philadelphia: Saunders; 2008.

    Kumar A, Patel S. Focus on: shock and pressors. American College of Emergency Physicians website. Available at: http://www.acep.org/webportal/membercenter/periodicals/an/2006/oct/shockpressors.htm . Accessed October 26, 2006.

    Marx JA, et al. Rosen's Emergency Medicine.7th ed. St. Louis, MO: Mosby, Inc.; 2009.

    Shock: first aid. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/first-aid-shock/FA00056 . Accessed October 26, 2006.

    The signs of hypovolemic shock. Health Guidance website. Available at: http://www.healthguidance.org/entry/12784/1/The-Signs-of-Hypovolemic-Shock.html . Accessed April 11, 2011.

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