Monday, October 8, 2018

Shock!, an article on Alpharubicon


Shock at its most basic level is the lack of equilibrium between the cell’s need for oxygen and the body’s inability to provide that cellular oxygen...The body’s response to shock usually occurs in stages.

The first stage of shock is (where) cardiac output is seen to decrease, causing an impairment of the tissue perfusion. This action ...causes a sudden increase in waste products called lactic acid that further injures the cells which causes further cell death in a cyclical fashion.

The (second) stage where the body tries to compensate for the lack of equilibrium...The heart rate will increase, the vessels of the body will begin constricting and the body will begin to retain sodium and water...the blood glucose levels will begin to rise and the respiratory rate will increase (hyperventilation) in an attempt to blow off the effects of lactic acidosis.

The (third) stage is characterized by the cycle begins to self-perpetuate a downward spiral which can end in death. During this stage the cells are functioning on anaerobic metabolism which is causing a buildup of lactic acid. Anaerobic metabolism does not produce enough energy to sustain cellular life and cells begin to die...At this point even if you could give the cells more oxygen, it would be futile because they couldn’t process it and use it....the patient will reach a point of no return.

Types of Shock
Hypovolemic shock is the most common type of shock. It is the type of shock that occurs from a lack of sufficient fluid in the intravascular space. The etiology of this is that the hypovolemic shock can occur one of two ways. The first way is an external loss of body fluid such as blood or plasma.

Cardiogenic shock is (similar to hypovolemic shock) where the heart is unable to pump forward the amount of blood in one stroke to support life. This can occur for several reasons...(like) ischemia of the left ventricle, structural problems and dysrhythmias.

Distributive shock is a condition where the flow of blood is not evenly distributed. It is actually an umbrella for three other forms of shock. They are septic, anaphylactic and neurogenic shock. All of these are forms of distributive shock.

Anaphylactic shock is when the body’s antibody-antigen response is triggered by something the person is allergic to...The pathophysiology of anaphylactic shock is that when the antibody-antigen response is triggered they in turn trigger the release of biochemical mediators. These mediators(create a cascade if events that look like cardiogenic shock).

Neurogenic shock is the type of distributive shock that is caused by the suppression or outright loss of sympathetic tone. Neurogenic shock is the rarest form of shock. The etiology is anything which causes any disruption of the sympathetic nervous system. Some examples of this are spinal injury, spinal anesthesia, drugs and emotional stress to name a few.

Sepsis is another form of distributive shock. Sepsis is, as most people know, a really bad infection that can kill you.
In conclusion, while shock as a condition might be at first confusing it can be broken down and explained in simple terms. There are five basic forms of shock and they include neurogenic, septic, anaphylactic, hypovolemic, and cardiogenic. The basic treatment is oxygen and respiratory support, fluid support, and pharmacological (drugs) support.

I thought this was an outstanding article. I probably exceeded the strict limits on "fair usage" even though I trimmed out two-thirds of the text and hope that a few of you follow the link to the originating site.


  1. And IMMEDIATE treatment is required in all cases... sigh

    1. Yup. Foremost, stop the bleeding.

      I don't know what the current recommendations are, but the old standard was to get patient horizontal to assist preloading of heart and to keep warm to reduce metabolic loading.