What is a Shock?
Shock is a critical condition that results from inadequate tissue delivery of O2 and
nutrients to meet tissue metabolic demand.
Shock does not depend upon blood pressure, shock can occur with a normal,
increased or decreased systolic blood pressure.
In children most shock is characterized by low cardiac output; however in shock
caused by sepsis or anaphylaxis, CO may be high.
All types of shock result in impairment of vital organs such as Brain and Kidney.
Shock can result from:
Inadequate blood volume or oxygen carrying capacity (Hypovolemic Shock,
including hemorrhagic shock)
Inappropriate distribution of blood volume and flow (Distributive shock)
Impaired cardiac contractility (Cardiogenic shock)
Obstructed blood flow (Obstructive shock)
Shock can be categorized into 4 basic types.
1. Hypovolemic
2. Distributive
Septic Shock
Anaphylactic Shock
Neurogenic Shock
3. Cardiogenic
4. Obstructive
Hypovolemic shock:
Most common cause of shock in children
Typically represents depletion of both intravascular and extravascular fluid
volume.
Adequate fluid resuscitation often require administration of fluid boluses that
exceed the volume of the estimated intravascular deficit.
Hypovolemic Shock is characterized by decreased preload leading to reduced
stroke volume and low cardiac output.
Tachycardia, Increased SVR and Increased cardiac contractility are the main
compensatory mechanisms.
V
olume loss can result from:
Diarrhea
Vomiting
Hemorrhage (Internal and External)
Inadequate fluid intake
Osmotic diuresis (DKA)
Third space losses (Fluid leak into tissues)
Large Burns
Distributive shock:
It is characterized by inappropriate distribution of blood volume with inadequate organ
and tissue perfusion (especially the splanchnic vascular bed)
Most common forms are.
Septic Shock
Anaphylactic Shock
Neurogenic Shock (Ex: Head Injury, Spinal Injury)
Septic Shock:
Most common form of Distributive shock. It is caused by infectious organisms or their
byproducts(endotoxin) that stimulate the immune system and trigger the release of
inflammatory mediators.
Typically evolves from a systemic inflammatory response in early stages to septic
shock in the late stages, may evolve over days or just a few hours.
In the early stages, signs are often subtle and may be difficult to recognize because
peripheral perfusion may appear to be good. Child may have fever or hypothermia and
WBC may be decreased, normal or increased.
Anaphylactic Shock:
Anaphylactic shock is an acute multisystem allergic response caused by a severe
reaction to a drug, vaccine, food, toxin, plant, venom, or other antigen. It can occur
within seconds to minutes.
The reaction is characterized by vasodilation, arterial vasodilation, increased capillary
permeability and pulmonary vasoconstriction.
Signs may include Anxiety or agitation, Nausea and vomiting, Urticaria, Angioedema
(swelling of face, lips and tongue), Respiratory distress with stridor or wheezing,
Hypotension, Tachycardia.
N
eurogenic Shock
Also known as spinal shock, and results from a cervical or upper thoracic (above T6)
injury that disrupts the sympathetic nervous system of blood vessels and the heart.
Sudden loss of the sympathetic nervous system signals to the smooth muscle in the
vessel results
in uncontrolled vasodilation.
The primary signs are.
Hypotension with a wide pulse pressure
Normal heart rate or Bradycardia Other signs include increased RR.
Diaphragmatic breathing, motor, or sensory deficits.
Cardiogenic Shock:
Cardiogenic shock results from inadequate tissue perfusion secondary to myocardial
dysfunction.
Common causes include CHD, Myocarditis, Cardiomyopathy, Arrhythmias, Sepsis,
Poisoning or drug toxicity, Myocardial Injury (ex: trauma)
Cardiogenic shock is characterized by marked tachycardia, high SVR, and decreased
cardiac output.
O
bstructive Shock:
In obstructive shock, cardiac output is impaired by a physical obstruction of blood flow.
Causes include.
Cardiac Tamponade
Tension Pneumothorax
Duct-dependent congenital heart lesions
Massive pulmonary embolism
The physical obstruction to blood flow results in low cardiac output, inadequate tissue perfusion
and a compensatory increase in SVR.
Recognition of Shock:
References:
https://es.scribd.com/doc/220952229/Mgmt-of-Shock-Flowchart
https://www.researchgate.net/profile/Monira-Ismail/publication/
317577007_Pathophysiology_and_management_of_different_types_of_s
hock/links/5c837807458515831f92f72f/Pathophysiology-and-
management-of-different-types-of-shock.pdf
https://europepmc.org/article/med/11753724
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