Shock

Introduction
• Shock can refer to a range of related medical conditions in
which the victim's heart, lungs and blood cannot deliver oxygen
to the body properly. Shock is not a diagnosis or condition, it is
always a symptom of a larger problem, and is a medical
emergency that requires immediate attention. One should never
confuse true shock with a feeling of extreme surprise - one does
not lead to the other.
Epidemiology
• 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.
Neurogenic shock
• A type of shock (a life-threatening medical condition in which
there is insufficient blood flow throughout the body) that is
caused by the sudden loss of signals from the sympathetic
nervous system that maintain the normal muscle tone in blood
vessel walls. The blood vessels relax and become dilated,
resulting in pooling of the blood in the venous system and an
overall decrease in blood pressure. Neurogenic shock can be a
complication of injury to the brain or spinal cord.
Pathophysiology of neurogenic shock
• Because it causes a loss of sympathetic tone, which plays a
major role in other forms of shock, neurogenic shock causes a
unique and atypical presentation.
• Typically, in other forms of shock, the sympathetic nervous
system triggers various compensatory mechanisms by
releasing epinephrine and norepinephrine, its major chemical
mediators. These neurotransmitters trigger an increased heart
rate, faster breathing, and sweating. They also
trigger vasoconstriction, to shunt blood away from
the extremities and to the vital organs.
• In neurogenic shock, the body loses its ability to activate the
sympathetic nervous system and cannot trigger these
compensatory mechanisms. Only parasympathetic tone
remains. Consequently, neurogenic shock’s unique presentation
includes:
• Neurogenic shock is diagnosed based on a person's symptoms
and blood pressure levels. Symptoms of neurogenic shock
include sweaty, cool skin; labored breathing, low blood
pressure; dizziness; and anxiety. Many people with neurogenic
shock have suffered an injury to the nervous system, such as
the spinal cord.
Signs and symptoms
• Instantaneous hypotension due to sudden, massive vasodilation
• Warm, flushed skin due to vasodilation and inability to constrict
blood vessels.
• Priapism, also due to vasodilation
• The patient will be unable to get tachycardic, and may
become bradycardic
• If the injury is below C5, the patient will exhibit diaphragmatic
breathing due to loss of nervous control of the intercostal
muscles (which are required for thoracic breathing).
• If the injury is above C3, the patient will go into respiratory
arrest immediately following the injury, due to loss of nervous
control of the diaphragm.
Treatment
• Treating neurogenic shock Then they will give you fluids
intravenously to regulate your blood pressure. If your blood
pressure is too low, you may be given vasopressors, or
medication that helps to tighten your blood vessels and raise
pressure. Some of the most common vasopressors include:
norepinephrine.