Shock (Circulatory shock) : Symptoms, Causes, Diagnosis & Treatment

Shock is a life-threatening circulatory disorder that leads to tissue hypoxia and a disturbance in microcirculation. There are many different causes of shock, which are classified into cardiogenic shock (e.g., as a result of acute heart failure or cardiac tamponade), hypovolemic shock (e.g., following massive blood or fluid loss), and shock due to a disturbance in the fluid distribution in the body (septic, anaphylactic, and neurogenic shock). The common clinical findings are hypotension and tachycardia, accompanied by specific symptoms related to the cause of shock. Hypoxia can result in organ damage and complex metabolic disorders such as kidney failure, DIC (disseminated intravascular coagulation), ARDS (acute respiratory distress syndrome), and circulatory collapse. Management of shock involves circulatory support and the treatment of the underlying cause. Shock is associated with a very high mortality rate.

Different types of shocks are explained below :

Hypovolaemic – meaning not enough blood volume. Causes include bleeding, which could be internal (such as a ruptured artery or organ) or external (such as a deep wound) or dehydration. Chronic vomiting, diarrhoea, dehydration or severe burns can also reduce blood volume and cause a dangerous drop in blood pressure

Cardiogenic – caused when the heart cannot effectively pump blood around the body. Various conditions including heart attack, heart disease (such as cardiomyopathy) or valve disorders may prevent a person’s heart from functioning properly

Neurogenic – injury to a person’s spine may damage the nerves that control the diameter (width) of blood vessels. The blood vessels below the spinal injury relax and expand (dilate) and cause a drop in blood pressure

Septic – an infection makes the blood vessels dilate, which drops blood pressure. For example, an E. coli infection may trigger septic shock

Anaphylactic – a severe allergic reaction causes blood vessels to dilate, which results in low blood pressure

Obstructive – blood flow is stopped. Obstructive shock can be caused by cardiac (pericardial) tamponade, which is an abnormal build-up of fluid in the pericardium (the sac around the heart) that compresses the heart and stops it from beating properly, or pulmonary embolism (a blood clot in the pulmonary artery, blocking the flow of blood to the lungs)

Endocrine – in a critically ill person, a severe hormonal disorder such as hypothyroidism may stop the heart from functioning properly and lead to a life-threatening drop in blood pressure.

Haemorrhagic shock occurs in about 1–2% of trauma cases. Up to one-third of people admitted to the intensive care unit (ICU) are in circulatory shock. Of these, cardiogenic shock accounts for approximately 20%, hypovolemic about 20%, and septic shock about 60% of cases.

How does Shock affect your body?

At a cellular level, shock is the process of oxygen demand becoming greater than oxygen supply. One of the key dangers of shock is that it progresses by a positive feedback mechanism. Poor blood supply leads to cellular damage, which results in an inflammatory response to increase blood flow to the affected area. This is normally very useful to match up blood supply level with tissue demand for nutrients. However, if enough tissue causes this, it will deprive vital nutrients from other parts of the body. Additionally, the ability of the circulatory system to meet this increase in demand causes saturation, and this is a major result, of which other parts of the body begin to respond in a similar way; thus, exacerbating the problem. Due to this chain of events, immediate treatment of shock is critical for survival.

What are the Causes of Shock?

Common causes include :

  • Low blood volume (hypovolemic shock)
  • Inadequate pumping action of the heart (cardiogenic shock)
  • Excessive widening of blood vessels (distributive shock)

What are the Risk Factors of Shock ?

Common risk factors include :

  • Increasing age
  • Myocardial infarction
  • Cardiomyopathy
  • Heart valve disease
  • Arrhythmias
  • Trauma
  • Gastrointestinal bleeding
  • Ruptured abdominal aortic aneurysm
  • Burns/heat stroke
  • Gastrointestinal losses: diarrhea and vomiting
  • Pancreatitis
  • Sepsis
  • Anaphylaxis/poisoning
  • Spinal or brainstem injury
  • Endocrine disease
  • Pulmonary embolism

What are the symptoms of Shock?

Common symptoms include :

  • Pale, cold, clammy skin
  • Shallow, rapid breathing
  • Difficulty breathing
  • Anxiety
  • Rapid heartbeat
  • Heartbeat irregularities or palpitations
  • Thirst or a dry mouth
  • Low urine output or dark urine
  • Nausea
  • Vomiting
  • Dizziness
  • Light-headedness
  • Confusion and disorientation
  • Unconsciousness.

How is Shock diagnosed?

Blood pressure measurement – People in shock have very low blood pressure.

Electrocardiogram (ECG) – This test records the electrical activity of your heart via electrodes attached to your skin. If you have damaged heart muscle, electric problems or fluid buildup around your heart, it won’t conduct electrical impulses normally.

Chest X-ray – This allows your doctor to check the size and shape of your heart and its blood vessels and whether there’s fluid in your lungs.

Blood tests – You’ll have blood drawn to check for organ damage, infection and heart attack. Another type of blood test called arterial blood gas might be used to measure oxygen in your blood.

Echocardiogram – Sound waves produce an image of your heart that can help identify damage from a heart attack.

Cardiac catheterization (angiogram) – A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that’s inserted through an artery, usually in your leg. The dye makes your arteries visible on X-ray, revealing areas of blockage or narrowing.

How to prevent & control Shock?

Don’t smoke and avoid secondhand smoke – Several years after quitting smoking, your risk of shock is the same as that of a nonsmoker.

Maintain a healthy weight – Being overweight contributes to other risk factors for heart attack and cardiogenic shock, such as high blood pressure, cardiovascular disease and diabetes. Losing just 10 pounds (4.5 kilograms) can lower blood pressure and improve cholesterol levels.

Eat less cholesterol and saturated fat – Limiting these, especially saturated fat, can reduce your risk of heart disease. Avoid trans fat.

Limit added sugar and alcohol – This will help you avoid nutrient-poor calories and help you maintain a healthy weight.

Exercise regularly – Exercise can lower your blood pressure, increase your level of high-density lipoprotein (HDL) cholesterol, and improve the overall health of your blood vessels and heart. Gradually work up to 30 minutes of activity — such as walking, jogging, swimming or bicycling — on most, if not all, days of the week.

Treatment of Shock Allopathic Treatment

Specific treatment depends on the type of shock, but could include:

Hypovolaemic shock – stopping the bleeding and boosting the person’s blood volume with intravenous fluids (fluids given directly into the person’s bloodstream through a tube and needle). In severe cases, the person may need a blood transfusion. Internal or external wounds may need surgery

Cardiogenic shock – boosting blood volume with intravenous fluids. Medications to constrict (narrow) the blood vessels will improve the heart’s ability to pump. Some people may need heart surgery

Neurogenic shock – giving intravenous fluids and medications, including corticosteroids

Septic shock – giving antibiotics for the infection. The person may need supportive hospital care, for example, mechanical ventilation to help them breathe

Anaphylactic shock – the person may need medications such as antihistamines, adrenaline or corticosteroids

Obstructive shock – removing the obstruction, for example, surgery or clot-dissolving medication to remove a blood clot in the pulmonary artery

Endocrine shock – administering medications to correct the hormonal imbalance, for example, thyroid medication to treat hypothyroidism.

Treatment of Shock Homeopathic Treatment

Common medications include :

  • Ignatia Amara
  • Arnica Montana
  • Aconite
  • Hypericum Perforatum

Shock – Lifestyle Tips

Learn ways to prevent heart disease, injuries, dehydration and other causes of shock.

If you have a known allergy, carry an epinephrine pen, which your doctor can prescribe. Avoid severe allergy triggers.

What are Recommended Exercises for Person with Shock?

No data is available regarding this.

Shock & Pregnancy – Things to know

The treatment of shock in a pregnant woman differs in 2 important respects from the treatment of shock in other adults. First, normal physiologic changes occur in the most organ systems during pregnancy. Second, the mother and the fetus are both vulnerable during pregnancy. Therefore, obstetric critical care involves simultaneous assessment and management of the mother and fetus, who have differing physiologic profiles.

Common Complications Related to Shock

Shock leads to complete organ failure when inflammation and low blood pressure aren’t controlled. Between severe inflammation triggering blood clots and low blood pressure causing inadequate blood flow, your organs may not receive sufficient oxygen or blood to function properly. Kidney failure, heart dysfunction, respiratory failure, and multiple organ failure are all complications of shock.

Other FAQs about Shock

What does going into shock feel like?

The symptoms of shock include cold and sweaty skin that may be pale or gray, weak but rapid pulse, irritability, thirst, irregular breathing, dizziness, profuse sweating, fatigue, dilated pupils, lackluster eyes, anxiety, confusion, nausea, and reduced urine flow. If untreated, shock is usually fatal.

Why is a shock so dangerous?

Shock is a life-threatening condition that occurs when the body is not getting enough blood flow. Lack of blood flow means the cells and organs do not get enough oxygen and nutrients to function properly. Many organs can be damaged as a result. Shock requires immediate treatment and can get worse very rapidly.

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