Shock: Signs, Causes, Types and Treatment

When the organs and the tissues of the body are not receiving proper flow of blood, then such a medical condition is known as shock. Shock deprives the flow of oxygen into various organs of the body and induces piling up of waste materials. Shock, when becomes very serious, can also cause death.

There are three stages of shock are:

• Stage I: In the first stage of shock, the blood flow becomes low. This situation is called perfusion. As a result, the heart starts beating faster, blood vessels throughout the body becomes smaller in diameter, and the kidney starts retaining fluid into the circulatory system. All these accumulate to increase blood flow into the significant organs and organ systems of the body.
• Stage II: In the second stage of shock, the systems in the body cannot continue perfusion further, and other complications are noticed. Deprivation of oxygen into the brain and heart leads to disorientation of the patient and chest pain respectively.
• Stage III: In the third stage of this disorder, the prolonged time of perfusion further deteriorates the patient’s conditions. The heart and the kidney almost stop functioning, cells and other organs also start malfunctioning. Finally, the person dies if proper treatment is not given on time.

There are Four types of shocks are:

• Cardiogenic shock: In case of cardiogenic shock, inflammation of the heart muscles, heart attack, disturbances of the normal rhythmic heartbeat, fluid accumulation or clot in the heart are the common causes.
• Hypovolemic shock: When a person suffers from hypovolemic shock, reasons behind it may be excess fluid loss, dehydration, excess urination, extensive burns, blockage in the intestine and inflammation of the pancreas. All these reasons lead to lesser volume of blood in the body.
• Distributive shock:When your blood vessels lose their tone due to some conditions, it can cause distributive shock. The blood vessels become floppy and open that is not enough to supply blood pressure to your organs. There are a number of types of distributive shock which includes the following:
  • Septic shock: It can occur when any bacterial infection is allowed to stay in the body for a very long time without treatment. Bacteria produce toxins that spread throughout the body and damage the circulatory system.
  • Anaphylactic shock: This type of shock is a complication of a severe allergic reaction known as anaphylaxis. Allergic reactions occur when your body mistakenly treats a harmless substance as harmful which triggers a dangerous immune response. This type of shock is usually caused by allergic reactions to food, insect venom, medications, or latex.
  • Neurogenic shock: It is caused by damage to the central nervous system, usually a spinal cord injury. This causes blood vessels to dilate and skin feel warm and flushed. The heart rate slows, and the blood pressure drops very low.
• Obstructive shock: Obstructive shock is a type of shock which occurs when blood can not get where it needs to go. A pulmonary embolism is one condition that may cause an interruption to blood flow. Conditions that can cause a buildup of air or fluid in the chest cavity can also lead to obstructive shock.

Symptoms of shock include:

• Cold hands and feet
• Blue-tinged or pale skin
• Weak pulse rate
• Low blood pressure
• Drowsiness
• Fainting
• Blue or gray lips or fingernails
• Irritability
• Anxiety
• Dizziness
• Enlarged pupils
• Nausea or vomiting

Shock, which is a state of inadequate tissue perfusion, can be diagnosed by two methods which include clinical evaluation and test result trends. The first one is the most common method of diagnosis and is based upon clinical findings such as inadequate tissue perfusion, followed by signs such as tachycardia, tachypnea, and diaphoresis.

The second method is based upon the trends of laboratory findings, which involve both conditions i.e improving or worsening.

Shock is a situation where the human body is unable to receive optimum amount of blood in the body. Therefore to treat such a disorder, the proper amount of blood flow should be assured to all the important internal organs as well as in blood vessels and tissues. Treatment of circulatory shock can be done by securing the airway through intubation if required, so as to decrease the breathing and guarding against respiratory arrest.

Administration of intravenous fluids into the patient’s body is strongly recommended. It means that a certain quantity of saline water is to be given to the person suffering from this disorder. If the patient remains in shock even after the very first treatment mentioned above, then packed red blood cells should be given in order to keep the haemoglobin more than 100 g/L. Artificial oxygen provision is also suggested for treatment of shock.

Certain medicines can be used to treat shock. Vasopressors are used to increase blood pressure along with the body fluids. Dopamine and norepinephrine are the most commonly used vasopressors to treat shock. Activated protein C is also used to manage circulatory shock that occurs due to bacterial infection. Sodium bicarbonate is also used to treat shock, but the pH of NaHCO3 has to be less than 7, otherwise it would not show proper outcomes. Certain antibiotics are also used to treat shock.

Certain mechanical supports are provided to the patients to treat circulatory shock. Intra-aortic balloon pumps (IBAP) are used to increase myocardial oxygen perfusion as well as cardiac output at the same time. Once the cardiac output is increased, the coronary blood flow increases, thereby increasing the myocardial oxygen. A ventricular assisting device (VAP) helps in cardiac circulation by assisting one of the ventricles or both of the together to induce an optimum blood flow mechanism in the body.

An artificial heart can be used to support the damaged human heart if necessary. If the normal heart of the patient is malfunctioning too much and cannot pump blood properly, an artificial one can be installed after removing the original heart. If the heart is unable to pump optimum amount of blood and is using the exact amount of oxygen that is required to maintain a healthy body, an Extracorporeal Membrane Oxygenation System (ECMO) can be installed to let the heart perform its task in a normal way.

Shock is a state of medical emergency and needs to undergo hospitalization as early as possible. Some of the signs and symptoms that states the occurrence of the shock and evokes an emergency requirement for the treatment include the appearance of pale, cold, and clammy skin, anxiety, tachycardia, tachypnea, difficulty in breathing, palpitations, dry mouth, low urine output, nausea, vomiting, dizziness, confusion, and unconsciousness.

Shock is an emergency medical condition that is associated with a decreased blood flow to the body organs and seeks urgent medical consultation and care. However, some basic steps which need to be done in this state to ensure the survival of the individual are such as:

• Legs and feet should be elevated from the ground level.
• Tight clothes need to be loosened.
• The person in this state should not be allowed to eat or drink anything.
• If any sign of life such as breathing or moving is not being shown, CPR should be begun.
• The person should be kept still and not moved.
• In case bleeding occurs, continuous pressure using a cloth should be kept applied to the particular region.
• In case vomiting occurs, the body should be turned to prevent choking.

Vasopressin used can be sometimes harmful for the patient who is suffering from shock. There is a risk of having arrhythmia due to consumption of vasopressin. The usage of various electronic devices in trying to cure this disorder can lead to other problems.

The use of IBAP can lead to ischemia, occlusion of renal artery leading to kidney failure, cerebral embolism, infection and other problems. The use of VAD also has various side effects. It can lead to infections, heart failure, viral transmission and blood clotting leading to stroke. The usage of ECMO also has side effects like neurological injuries, heparin induced thrombocytopenia, intra-ventricular haemorrhage in children is quite common.

The complications of Shock are:

1. Cardiogenic Shock:
   • Heart muscle damage
   • Very slow heartbeats
   • Irregular heartbeats
2. Obstructive Shock:
   • Pneumothorax
   • Cardiac tamponade
   • Hemothorax
3. Distributive Shock:
   • Flushing
   • Loss of consciousness
   • Reduced blood pressure
4. Hypovolemic Shock:
   • Organ damage
   • Heartattack
   • Gangrene of legs and arms

The post-treatment guidelines for the treatment of the problem of shock are to see that the patient is having a proper blood circulation in the body. For that, the patient is to be taken for regular check-ups to the doctor. Checking the blood pressure should be done regularly, and the pressure should not be allowed to fall.

Urine tests and blood tests should be done regularly to keep a check on the body fluids; which cannot be allowed to become acidic in nature. If electronic devices are installed within the body of the patient, those should be also under regular check, as external devices to cure a person can also create problems within the body.

The shock occurring in body is a disorder that can be treated if the blood pressure and blood supply is kept optimum. This job is done by inducing a few external things into the body. But it is to be noted that there is no permanent recovery from the problem of shock.

The patient has to be kept under supervision throughout his/her life, especially if an external electronic device, say an artificial heart is installed within their body, then the patient may be released from the hospital within 5 to 10 days after the device has been installed, but needs to stay under constant supervision.

To recover from shock, it is quite important to de-stress the mind from anxiety and the state of shock. Hence there are some recommended foods and food habits that ease the symptoms of shock and help to get relief from it. Those include:

• Nutritious and easily digestible food items such as soups, stews, potatoes, and bakes.
• Intake of sleep-inducing teas such as Artemis deep sleep tea which allows better sleep.
• Incorporation of vitamins and minerals in the diet which mainly include magnesium sources as well as vitamin c sources.
• Water intake should be increased to prevent dehydration.
• Caffeine intake should be reduced as it affects the sleep cycle and evokes the symptoms of anxiety.

The treatment of shock that involves fluid intake and medicines are not costly at all. However, the cost of device installation to treat shock can vary between Rs. 3,90,000 to Rs.7,80,000 in India. This treatment is available in the leading hospitals of various metropolitan cities in India.

The treatment of problems of shock using mere medicines and fluids provides temporary relief. However, once the devices are installed in a person, he/she has to use it throughout life. With the aid of them, the affected person can survive properly and lead a normal life.

Certain careful measures can be taken by the affected person at home. The affected person’s airway, breathing and circulation can be checked every 2 minutes. The person should not be allowed to eat or drink anything when the shock occurs.

The person should be allowed to wear loose fitting clothes. Also, the best way to give an alternative treatment is to prevent shock from occurring. Whenever a person is suffering from immense dehydration due to diarrhoea or dysentery, he/she should be made to drink a lot of water. Food that produces blood should be taken regularly.