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.
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.
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.
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.
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.
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.
Low blood pressure, also referred to as hypotension, is blood pressure that is so low that it causes symptoms or signs due to the low flow of blood through the arteries and veins. Some of the symptoms of low blood pressure include light-headedness, dizziness, or even fainting if not enough blood is getting to the brain. Diseases and medications can also cause low blood pressure. When the flow of blood is too low to deliver enough oxygen and nutrients to vital organs such as the brain, heart, and kidneys; the organs do not function normally and may be permanently damaged.
Pneumonia is inflammation of one or both lungs with consolidation. Pneumonia is frequently but not always due to infection. The infection may be bacterial, viral, fungal or parasitic. Symptoms may include fever, chills, cough with sputum production, chest pain, and shortness of breath.
Congestive heart failure (CHF) is a condition in which the heart's function as a pump is inadequate to meet the body's needs. A poor blood supply resulting from congestive heart failure may cause the body's organ systems to fail, leading to a weakened heart muscle and fluid accumulation in the lungs and body tissue. There are many diseases that can impair pumping efficiency and symptoms of congestive heart failure including fatigue, diminished exercise capacity, shortness of breath, and swelling. Treatments include lifestyle modifications, medications, heart transplant, and therapy.
Staphylococcus or Staph is a group of bacteria that can cause a multitude of diseases. Staph infections can cause illness directly by infection or indirectly by the toxins they produce. Symptoms and signs of a Staph infection include redness, swelling, pain, and drainage of pus. Minor skin infections are treated with an antibiotic ointment, while more serious infections are treated with intravenous antibiotics.
Appendicitis is an inflammation of the appendix. Appendicitis often causes
fever, loss of appetite, and right lower
quadrant abdominal pain. Delay in surgery can result in appendix rupture with potentially serious complications.
Dehydration is the excessive loss of body water. There are a number of causes of dehydration including heat exposure, prolonged vigorous exercise, and some diseases of the gastrointestinal tract. The best way to treat dehydration is to prevent it from occurring.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
An ectopic pregnancy is a pregnancy located outside the inner lining of the uterus. The majority of ectopic pregnancies occur in the Fallopian tube. Symptoms include abdominal pain, amenorrhea, and vaginal bleeding. Treatment options include observation, medication, or surgery.
Dengue fever is contracted from the bite of a striped Aedes aegypti mosquito. Symptoms of dengue include headache, fever, exhaustion, severe joint and muscle pain, rash, and swollen glands. Since dengue is caused by a virus, there is no specific medicine to treat it. Treatment instead focuses on relieving the symptoms.
Heart attack happens when a blood clot completely obstructs a coronary
artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical
instability of the heart.
Abdominal aortic aneurysm is a ballooning or widening of the main artery (the aorta) as it courses down through the abdomen. The most common cause of aortic aneurysms is
"hardening of the arteries" called arteriosclerosis.
Internal bleeding occurs when an artery or vein is damaged and blood to escapes the circulatory system and collects inside the body. Internal bleeding can be caused by a variety of situations such as blunt trauma, deceleration trauma, medications, fractures, and spontaneous bleeding. Treatment of internal bleeding depends on the cause of the bleeding.
Sepsis (blood poisoning) is a potentially deadly infection with signs and symptoms that include elevated heart rate, low or high temperature, rapid breathing and/or a white blood cell count that is too high or too low and has more than 10% band cells. Most cases of sepsis are caused by bacterial infections, and some cases are caused by fungal infections. Treatment requires hospitalization, IV antibiotics, and therapy to treat any organ dysfunction.
Malaria is an infectious disease transmitted by the bite of an infected Anopheles mosquito. Symptoms of malaria include chills, pain, fever, and sweating. Though mild cases of malaria can be treated with oral medication, severe cases require intravenous drug treatment and fluids.
The spleen enlarges if it is asked to do excessive work in filtering or manufacturing blood cells, if there is abnormal blood flow to it, or if it is invaded with abnormal cells or deposits. Symptoms of an enlarged spleen may include weakness and fatigue, easy bleeding, and poor white blood cell function. Treatment of an enlarged spleen is focused toward the cause of the splenomegaly. Surgery may be required to remove the spleen.
Heat stroke (heatstroke or sun stroke) is a form of hyperthermia. Heat stroke is a true medical emergency that can be fatal if not promptly and properly treated. Symptoms of heat stroke include: high body temperature, absence of sweating, with hot red or flushed dry skin, rapid pulse, difficulty breathing, strange behavior, hallucinations, confusion, agitation, disorientation, seizure, and coma. A victim of heat stroke must receive immediate treatment to avoid permanent organ damage.
Vancomycin-resistant enterococci (VRE) infection is the most common type of infection acquired by patients while hospitalized. Patients at risk for VRE are those who are already ill, and hospitalized, including individuals with diabetes, elderly, ICU patients, kidney failure patients, or patients requiring catheters. Enterococci can survive for months in the digestive tract and female genital tract. Other risk factors for acquiring VRE include those how have been previously treated with vancomycin and combinations of other antibiotics. Treatment of VRE is generally with other antibiotics other than vancomycin. Prevention of VRE can be achieved by proper hand hygiene.
Heart rhythm disorders vary from minor palpitations, premature atrial contractions (PACs), premature ventricular contractions (PVCs), sinus tachycardia, and sinus brachycardia, to abnormal heart rhythms such as tachycardia, ventricular fibrillation, ventricular flutter, atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia (PSVT), Wolf-White-Parkinson syndrome, brachycardia, or heart blocks. Treatment is dependant upon the type of heart rhythm disorder.
Burns are categorized by severity as first, second, or third degree. First degree burns are similar to a painful sunburn. The damage is more severe with second degree burns, leading to blistering and more intense pain. The skin turns white and loses sensation with third degree burns. Burn treatment depends upon the location, total burn area, and intensity of the burn.
Anaphylaxis is a serious allergic reaction that affects a number of different areas of the body at one time, and can be fatal. Causes of anaphylaxis can be food allergy, latex allergy, allergy to insect or but stings/bites, asthma, or other materials or conditions. Symptoms include flushing, itching, hives, anxiety, rapid or irregular pulse. Severe symptoms may be throat and tongue swelling, swallowing, and difficulty breathing. Some disorders appear similar to anaphylaxis such as fainting, panic attacks, blood clots in the lungs, heart attacks, and septic shock. If you think that you may be having an anaphylactic reaction, seek emergency care or call 911 immedately.
Encephalitis is a brain inflammation that causes sudden fever, vomiting, headache, light sensitivity, stiff neck and back, drowsiness, and irritability. Meningitis is an infection that causes inflammation of the meninges that surround the brain and spinal cord. Symptoms of meningitis include high fever, headache, nausea, vomiting, and stiff neck.
Plague is an infectious disease caused by the Yersinia pestis bacteria, which is primarily found in rodents the fleas that feed off of them. The bacteria are passed to humans through flea or rodent bites. There are three forms of plague: bubonic, septicemic, and pneumonic. The symptoms and method of transmission vary with each form of plague. Plague can be treated with antibiotics.
In the United States, head injuries are one of the most common causes of death and disability. Head injuries due to bleeding are generally classified by the location of the blood within the scull, these include: epidural hematoma, subdural hematoma, subarachnoid bleed, intracranial bleed, sheer injury, edema, and skull fracture. Some common symptoms of a head injury include: vomiting, bleeding from the ear, speech difficulties, paralysis, difficulty swallowing, and body numbness. Treatment of a head injury depends on the type and severity of the injury.
Anthrax is a deadly infectious disease that may be transmitted to humans by infected animals or by biological warfare. There are three types of anthrax: cutaneous, inhalation, and gastrointestinal. Symptoms of cutaneous anthrax include a swollen glands, muscle ache, headache, fever, nausea, vomiting, and a red-brown raised spot that enlarges, blisters, and hardens, forming an ulcer crater with black crust. Symptoms of inhalation anthrax are flulike and may progress to respiratory distress, shock, coma, and death. Symptoms of gastrointestinal anthrax include loss of appetite, bloody diarrhea, and abdominal pain. Treatment for cutaneous anthrax involves penicillin, tetracycline, erythromycin, and ciprofloxin. Inhalation anthrax necessitates treatment with IV therapy with antibiotics.
Sunburn is caused by overexposure to UV radiation from the sun. UV rays can also damage the eyes. Repeated overexposure to UV rays also increases the risk for scarring, freckles, wrinkles, and dry skin. Symptoms of sunburn include painful, red, tender, and hot skin. The skin may blister, swell, and peel. Sun poisoning (severe sunburn) include nausea, fever, chills, rapid pulse, dizziness and more. Treatment for sunburn depends upon the severity. Sun protection and sunscreen for an individual's skin type is recommended to decrease the chance of sunburn.
Heart failure is caused by many conditions including coronary artery disease, heart attack, cardiomyopathy, and conditions that overwork the heart. Symptoms of heart failure include congested lungs, fluid and water retention, dizziness, fatigue and weakness, and rapid or irregular heartbeats.
Arsenic comes in two forms, inorganic and organic. Organic arsenic poisoning is usually not poisonous to humans; however, inorganic arsenic in large enough amounts can lead to shock and death. Symptoms of arsenic poisoning include nausea, abdominal pain, diarrhea, dehydration, dark urine, vertigo, delirium, shock, and death. Treatment for arsenic poisoning includes Hemodialysis and a variety of drugs.
Hyperthermia is the overheating of the body. Heat-related illnesses like heat stroke, heat exhaustion, heat cramps, heat rash, and sunburn are all hyperthermia conditions. Treatment of these conditions depends upon the condition, environment, and circumstances. Heat stroke is a medical emergency, and may result in death if not treated promptly. Heat exhaustion may lead to heat stroke if not treated properly.
The majority of stinging insects in the United States are from Bees, Yellow Jackets, Hornets, Wasps and Fire Ants. Severity of reactions to stings varies greatly. Avoidance and prompt treatment are essential. In selected cases, allergy injection therapy is highly effective.
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