Medical Shock

  • Medical Author:
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Shock facts

  • Shock is a life-threatening medical condition and is a medical emergency. If shock is suspected call 911 or get to an emergency department immediately.
  • The main symptom of shock is low blood pressure. Other symptoms include rapid, shallow breathing; cold, clammy skin; rapid, weak pulse; dizziness, fainting, or weakness.
  • There are several types of shock: septic shock caused by bacteria, anaphylactic shock caused by hypersensitivity or allergic reaction, cardiogenic shock from heart damage, hypovolemic shock from blood or fluid loss, and neurogenic shock from spinal cord trauma.
  • Treatment for shock depends on the cause. Tests will determine the cause and severity. Usually IV fluids are administered in addition to medications that raise blood pressure.
    • Septic shock is treated with antibiotics and fluids.
    • Anaphylactic shock is treated with diphenhydramine (Benadryl), epinephrine (an "Epi-pen"), and steroid medications (solu-medrol).
    • Cardiogenic shock is treated by identifying and treating the underlying cause.
    • Hypovolemic shock is treated with fluids (saline) in minor cases, and blood transfusions in severe cases.
    • Neurogenic shock is the most difficult to treat as spinal cord damage is often irreversible. Immobilization, anti-inflammatories such as steroids and surgery are the main treatments.
  • Shock prevention includes learning ways to prevent heart disease, injuries, dehydration and other causes of shock.
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What is shock?

Shock is a life-threatening medical condition as a result of insufficient blood flow throughout the body. Shock often accompanies severe injury or illness. Medical shock is a medical emergency and can lead to other conditions such as lack of oxygen in the body's tissues (hypoxia), heart attack (cardiac arrest) or organ damage. It requires immediate treatment as symptoms can worsen rapidly.

Medical shock is different than emotional or psychological shock that can occur following a traumatic or frightening emotional event.

What are the types of shock?

Septic shock results from bacteria multiplying in the blood and releasing toxins. Common causes of this are pneumonia, urinary tract infections, skin infections (cellulitis), intra-abdominal infections (such as a ruptured appendix), and meningitis.

Anaphylactic shock is a type of severe hypersensitivity or allergic reaction. Causes include allergy to insect stings, medicines, or foods (nuts, berries, seafood), etc.

Cardiogenic shock happens when the heart is damaged and unable to supply sufficient blood to the body. This can be the end result of a heart attack or congestive heart failure.

Hypovolemic shock is caused by severe blood and fluid loss, such as from traumatic bodily injury, which makes the heart unable to pump enough blood to the body, or severe anemia where there is not enough blood to carry oxygen through the body.

Neurogenic shock is caused by spinal cord injury, usually as a result of a traumatic accident or injury.

What are the causes of shock?

There are several main causes of shock:

  • Heart conditions (heart attack, heart failure)
  • Heavy internal or external bleeding, such as from a serious injury or rupture of a blood vessel
  • Dehydration, especially when severe or related to heat illness.
  • Infection (septic shock)
  • Severe allergic reaction (anaphylactic shock)
  • Spinal injuries (neurogenic shock)
  • Burns
  • Persistent vomiting or diarrhea

What are the symptoms of shock?

Low blood pressure and rapid heart rate (tachycardia) are the key signs of shock.

Symptoms of all types of shock include:

  • Rapid, shallow breathing
  • Cold, clammy skin
  • Rapid, weak pulse
  • Dizziness or fainting
  • Weakness

Depending on the type of shock the following symptoms may also be observed:

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When should I seek medical care for shock?

Medical shock is a medical emergency. If you suspect shock after an injury, even if the person seems stable, call 911 or get them to an emergency department immediately. Prompt treatment can save a person's life.

The sooner shock is treated, the better. When treated quickly there is less risk of damage to a person's vital organs.

What is the treatment for shock?

Depending on the type or the cause of the shock, treatments differ. In general, fluid resuscitation (giving a large amount of fluid to raise blood pressure quickly) with an IV in the ambulance or emergency room is the first-line treatment for all types of shock. The doctor will also administer medications such as epinephrine, norepinephrine, or dopamine to the fluids to try to raise a patient's blood pressure to ensure blood flow to the vital organs.

Tests (for example, X-rays, blood tests, EKGs) will determine the underlying cause of the shock and uncover the severity of the patient's illness.

Septic shock is treated with prompt administration of antibiotics depending on the source and type of underlying infection. These patients are often dehydrated and require large amounts of fluids to increase and maintain blood pressure.

Anaphylactic shock is treated with diphenhydramine (Benadryl), epinephrine (an "Epi-pen"), steroid medications methylprednisolone (Solu-Medrol), and sometimes a H2-Blocker medication (for example, famotidine [Pepcid], cimetidine [Tagamet], etc.).

Cardiogenic shock is treated by identifying and treating the underlying cause. A patient with a heart attack may require a surgical procedure called a cardiac catheterization to unblock an artery. A patient with congestive heart failure may need medications to support and increase the force of the heart's beat. In severe or prolonged cases, a heart transplant may be the only treatment.

Hypovolemic shock is treated with fluids (saline) in minor cases, but may require multiple blood transfusions in severe cases. The underlying cause of the bleeding must also be identified and corrected.

Neurogenic shock is the most difficult to treat. Damage to the spinal cord is often irreversible and causes problems with the natural regulatory functions of the body. Besides fluids and monitoring, immobilization (keeping the spine from moving), anti-inflammatory medicine such as steroids, and sometimes surgery are the main parts of treatment.

Self-Care at Home

  • Call 911 for immediate medical attention any time a person has symptoms of shock. Do not wait for symptoms to worsen before calling for help. Stay with the person until help arrives, and if possible, stay on the line with the 911 dispatcher because they may have specific instructions for you.
  • While waiting for help or on the way to the emergency room, check the person's airway, breathing and circulation (the ABCs). Administer CPR if you are trained. If the person is breathing on his or her own, continue to check breathing every 2 minutes until help arrives.
  • Do NOT move a person who has a known or suspected spinal injury (unless they are in imminent danger of further injury).
  • Have the person lie down on his or her back with the feet elevated above the head (if raising the legs causes pain or injury, keep the person flat) to increase blood flow to vital organs. Do not raise the head.
  • Keep the person warm and comfortable. Loosen tight clothing and cover them with a blanket.
  • Do not give fluids by mouth, even if the person complains of thirst. There is a choking risk in the event of sudden loss of consciousness.
  • Give appropriate first aid for any injuries.
  • Direct pressure should be applied to any wounds that are bleeding significantly.

Can shock be prevented?

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 is the outlook for shock?

Prompt treatment of medical shock is essential for the best outcome. Moreover, the outlook depends on the cause of the shock, the general health of the patient, and the promptness of treatment and recovery.

  • Generally, hypovolemic shock and anaphylactic shock respond well to medical treatment if initiated early.
  • Septic shock is a serious condition with a mortality rate of 24% to 50% according to some estimates. The sooner the infection is treated and fluids are administered, the greater the chances of success. Hospitals are now developing and utilizing specific protocols to identify and aggressively treat septic shock patients.
  • Cardiogenic shock has a poor prognosis, with only 1/3 of patients surviving. Because this type of shock results from injury or dysfunction of the heart it is often difficult to treat and overcome.
  • Spinal shock also has a very poor prognosis because the spinal cord mediates so many important bodily functions. There are currently very few effective treatments but medical research is making advances in the treatment of spinal injuries.

Medically reviewed by Joseph Palermo, DO; American Osteopathic Board Certified Internal Medicine

REFERENCES:

MedscapeReference.com. Septic Shock Prognosis.

MedscapeReference.com. Cardiogenic Shock.

Last Editorial Review: 8/10/2016

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Reviewed on 8/10/2016
References
Medically reviewed by Joseph Palermo, DO; American Osteopathic Board Certified Internal Medicine

REFERENCES:

MedscapeReference.com. Septic Shock Prognosis.

MedscapeReference.com. Cardiogenic Shock.

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