He state of shock Is a condition in which there is not enough oxygen in the blood because the blood pressure is very low.
This causes the organs and tissues to not have the oxygen they need, causing the cells to die and accumulate debris.
There are very different conditions that can cause the blood pressure drop that, as a consequence, produce a state of shock.
Some of them are decreased blood volume, malfunction of the Sympathetic nervous system , Hormonal alterations, allergies, etc. According to their causes, the shock state can be classified into different subtypes.
The word shock is used differently in the medical field and in the general public. Popularly it is used to define an intense emotional reaction that arises in front of stressful situations, like receiving bad news.
In this case, the shock state refers to a loss of oxygen in the blood resulting in symptoms such as increased heart rate, confusion, or fatigue.
Shock is a medical emergency that can cause serious injury, and even death. That is why it must be dealt with immediately.
Why does the state of shock occur?
It is important to mention that it is essential for cells to have oxygen and glucose . This allows them to generate energy and do their job properly.
Oxygen enters the body through the lungs. From these the oxygen reaches the blood. In particular, it is stored in the red blood cells, binding to the molecules of hemoglobin . Red blood cells travel throughout the body thanks to the pumping of the heart, carrying oxygen to cells and tissues.
However, if the cells do not have oxygen, instead of using the aerobic metabolism (with oxygen) they use the anaerobic metabolism (without oxygen). This metabolism creates lactic acid As a by-product.
This causes the acid-base balance in the blood to be changed. That is, it becomes more acidic, starting to release toxins that are going to affect the blood vessels.
Finally, the anaerobic metabolism causes the cells to die, which harms different tissues and organs.
Stages
Three stages are known in the state of shock, each of which has different symptoms.
Step I
In stage I (non-progressive), the body detects the low blood flow and sets in motion certain mechanisms to counteract it.
Thus, the heart beats faster, the blood vessels are reducing their diameter and the kidney tries to retain fluids. At this stage the shock does not have as many symptoms and a rapid treatment can stop it.
Step II
In stage II (progressive), the above mechanisms fail and begin to manifest identifiable symptoms. For example, the patient begins to feel confused by the lack of oxygen.
Step III
In stage III (irreversible) the low pressure affects the tissues and organs, the heart begins to be damaged and the kidneys collapse. At this stage serious damage can occur which could lead to death.
Symptoms of shock
The most common symptoms of shock are:
- Low blood pressure.
- Cold and wet skin. The hands and feet may have a pale or bluish color.
- The affected person can breathe quickly and with difficulty.
- Acceleration of heart rate.
- Nausea.
- Vomiting.
- Reduced urination.
- Fatigue.
- Dilated pupils.
- Dry mouth.
- Dizziness.
- Anxiety.
- Irritability.
- Confusion and drowsiness.
- Alteration of mental state, with reduced alertness. It can progress to loss of awareness .
Types
There are different types of shock according to the cause that produces it:
Hypovolaemic
It is characterized by a low volume of blood in the body. For a good functioning of the organism is necessary that there are enough red blood cells. It is also necessary that there is enough water in the blood so that fluids can move through the blood vessels. In fact, 90% of the blood is water.
When there is dehydration, there may be enough red blood cells, although there is not enough blood volume. This causes the blood pressure to decrease. Therefore, if there is less blood to pump, the heart must accelerate its pace to maintain production.
In the advanced stages of this type of shock state, the patient can not replace the amount of fluid lost and the body can not stabilize the blood pressure.
It may also be due to internal bleeding (for artery rupture or organ damage) or external bleeding (for example, a deep wound). This can also be called hemorrhagic shock.
Its most common causes are gastrointestinal bleeding and bleeding in the uterus in women. On the other hand, this state of shock is common in people with cancer.
This is because they are at increased risk of hemorrhage, since their liver does not allow adequate coagulation. People who take blood-thinning medications can also bleed excessively.
Other causes of hypovolemic shock may be chronic dehydration, burns, heat stroke, vomiting or diarrhea that can lead to loss of blood volume as well as a drop in blood pressure.
It is also associated with diseases that produce excessive urination (urine). Some of them are the Diabetes insipidus and the Mellitus diabetes . This is because excessively high blood sugar causes excess water to drain into the urine.
Inflammation of the pancreas, kidney failure or severe bleeding in the body can also lead to hypovolemic shock.
Cardiogenic
This occurs because the heart can not properly pump blood from the body. Its origin is linked to heart disease or heart attacks.
Neurogenic
This type of shock condition consists of a dysfunction of the sympathetic nervous system that lowers the blood circulation through the body. It causes the blood vessels to widen, causing blood to build up and blood pressure to fall.
Septic
This usually occurs by any type of bacteria, fungi, or virus (although to a lesser extent). When these infections are not treated properly, they lead to the appearance of certain toxins in the bloodstream.
As a result, cardiac muscle malfunction may occur. As well as a widening of the diameter of the blood vessels, accompanied by severe hypotension.
Toxins can damage the lungs, or produce acute respiratory failure. They can also cause kidney failure and liver failure.
Anaphylactic
It is a severe allergic reaction that causes a dilation of the blood vessels, resulting in a drop in blood pressure.
Obstructive
This state of shock is due to an obstruction of the blood flow that may be due to cardiac tamponade. For example, compression of the heart by the accumulation of fluid in the pericardium (a tissue that surrounds the heart). Or, for embolism (Blood clot in the arteries).
Endocrine
A serious hormonal disorder can cause the heart to malfunction, giving blood pressure drops.
Treatment
It should be noted that the shock state is a medical emergency that needs immediate treatment. In the presence of symptoms, you should contact emergency services as soon as possible.
First aid is critical to saving the patient's life. If the person is conscious, it is best to lay her down and keep her comfortable and warm.
It is advisable to take the legs and raise them above the level of the torso and the head. It is important not to move the person if you suspect you have spinal cord injuries or leg fractures.
If the patient has bleeding, he can try to control himself temporarily by pressing with a clean cloth on the wound. If the cloth is soaked it should be replaced or replaced. It is important to keep the pressure in place constantly.
Although the person is thirsty, it is recommended not to give him drinks or food. It is best to keep the patient calm and not moving.
The treatment of the state of shock varies according to the underlying causes, that is, of the type of shock that the person has experienced.
Thus, in hypovolemic shock, blood volume may need to be increased by blood transfusions.
While in cardiogenic shock, the indicated treatment is the application of drugs that narrow the blood vessels so that the heart can pump blood more easily. The volume of blood can also be boosted by intravenous fluids.
The treatment of neurogenic shock mainly consists of the administration of liquids in the veins and of medications such as corticosteroids.
When it comes to septic shock, treatment with antibiotics may be necessary to stop the infection.
On the other hand, anaphylactic shock requires the administration of medications such as antihistamines, corticosteroids or adrenalin .
When obstructive shock occurs, the obstruction needs to be removed. Anticoagulant drugs can be used to dissolve clots in the arteries.
Finally, in endocrine shock drugs must be used to achieve a hormonal balance. For example, if it is due to Hypothyroidism , Drugs must be prescribed to treat it.
References
- A basic overview of shock. (February 8, 2016). Retrieved from EMS1: ems1.com.
- Cicetti, F. (April 26, 2013). What Is Shock? Retrieved from Livescience: livescience.com.
- Medical Shock. (S.f.). Retrieved on April 24, 2017, from MedicineNet: medicinenet.com.
- Shock. (S.f.). Retrieved April 24, 2017, from the University of Maryland Medical Center (UMMC): umm.edu.
- Shock. (S.f.). Recovered on April 24, 2017, from Better Health Channel: betterhealth.vic.gov.au.
- Shock. (May 24, 2016). Retrieved from"Emedicine Health: emedicinehealth.com".