Signs and Symptoms
Common signs and symptoms of shock include:
- Low blood pressure
- Altered mental state, including reduced alertness and awareness, confusion, and sleepiness
- Cold, moist skin. Hands and feet may be blue or pale
- Weak or rapid pulse
- Rapid breathing and hyperventilation
- Decreased urine output
In septic shock (from overwhelming blood infection): shaking chills, rapid temperature increase, warm, flushed skin, and rapid pulse.
In shock related to heart problems: lung congestion, rapid pulse, heart murmur, and enlarged neck veins.
What Causes It?
Shock can have several causes. Doctors classify shock according to categories:
- Loss of fluid in the bloodstream (hypovolemic shock). This occurs after heavy bleeding from an injury or a condition, such as bleeding ulcers. Hypovolemic shock can also occur if your body loses too many fluids other than blood (such as losing water after severe diarrhea or vomiting, or losing plasma after serious burns).
- Blood vessels become too dilated (distributive shock). If the blood vessels expand too much, they are not able to keep blood circulating to all organs. Septic shock, which occurs when bacteria invade the bloodstream, and anaphylactic shock, which is a severe allergic reaction, are examples.
- Heart problems (cardiogenic shock). In this case, the heart does not pump enough blood through the body. It can be caused by a heart attack, abnormal heart rhythm, or damage to the heart from heart disease.
Who is Most At Risk?
The following conditions and characteristics increase the risk for shock:
- Serious injury and trauma
- Heart conditions, such as heart disease or heart attack
- Surgery
- Bacterial infection that has spread to the blood
- Bleeding
- Losing large volume of fluids from severe diarrhea or vomiting
- Excessive alcohol use
- Severe anemia
- Weakened immune system
- Allergic reaction to a drug, food, or environmental exposure
- Drug overdose
- Pregnancy
What to Expect at Your Provider's Office
Shock is an emergency and requires immediate conventional treatment. Your health care provider will diagnose shock based on your symptoms and any information about underlying disease or recent injury. Your provider will check blood pressure, assess mental status (memory, orientation, and alertness), measure urine output, and order blood tests to check heart, lung, and kidney function, and search for evidence of sepsis (blood infection). You may also undergo imaging tests and other procedures, such as x-ray, electrocardiography (ECG), echocardiography, and ultrasonography, to check the heart.
Treatment Options
Prevention
If you have heart disease or another condition that makes you susceptible to shock, you should seek treatment for that condition. If you have severe allergies, avoid substances that may trigger anaphylactic shock and carry self-injectable epinephrine to treat anaphylaxis.
Treatment Plan
The main goals of treatment are to maintain blood pressure and to make sure the person's vital organs get enough blood and oxygen. First aid for shock includes having the person lie on their back, raising their legs to help blood return to the heart, stopping any bleeding, covering them with a coat or blanket to ensure warmth, and performing cardiopulmonary resuscitation (CPR), if needed. Emergency medical staff will administer oxygen, and in the case of hypovolemic and septic shock, intravenous fluids.
Drug Therapies
Doctors may prescribe the following medications to treat shock:
- Drugs that increase pressure in the arteries and help the heart pump more blood, such as dopamine, dobutamine, and norepinephrine
- Medications to either dilate or constrict blood vessels (depending on the cause of shock)
- Antibiotics for septic shock, to combat wide-ranging infection
- Corticosteroids to reduce the incidence of vasopressor dependent septic shock
- Thrombolytic therapy (drugs that dissolve clots as they form) in the case of heart attack or pulmonary embolism
Complementary and Alternative Therapies
Shock is always life threatening and requires emergency conventional medical care. Some complementary and alternative therapies (CAM), however, may be used along with conventional treatment after a person's condition stabilizes, to help prevent shock. For instance, certain nutrients may help protect against the harmful effects of shock and improve the outcome of conventional treatment.
Nutrition and Supplements
Oxidative stress (damage to cells caused by the body's normal use of oxygen) may play a role in shock. Several studies show that antioxidants may protect against some types of shock, however, most of these studies have been done in animal. It is not known whether these supplements will also benefit humans.
You may address nutritional deficiencies with the following supplements:
- A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium.
- Omega-3 fatty acids, such as fish oil (1 to 2 capsules or 1 to 2 tbsp. daily), for inflammation. Omega-3 fatty acids can have a blood-thinning effect, and can interact with other blood-thinning medications, such as warfarin (Coumadin) and aspirin.
- Vitamin C, 1 to 6 gm daily, as an antioxidant. You may use higher doses. If diarrhea develops, lower dosage.
- Coenzyme Q10 (CoQ10), 100 to 200 mg at bedtime, for antioxidant support. CoQ10 can have a blood-thinning effect, and can interact with other blood-thinning medications, such as warfarin (Coumadin) and aspirin.
- L-carnitine, 500 to 2000 mg daily for support of a healthy cardiovascular system. In a study of people with septic, cardiac, or traumatic shock acetyl-L-carnitine helped return heart rate and blood pressure to normal and boosted oxygen delivery throughout the body. L-carnitine may interact with some medications, including thyroid hormone, warfarin (Coumadin), and others. Speak with your physician.
- Resveratrol (from red wine), 50 to 200 mg daily, for antioxidant effects.
Herbs
Shock always requires emergency conventional medical treatment. It should never be treated with herbs. Talk to your doctor before taking any herbs to treat or prevent shock.
Homeopathy
No scientific studies have evaluated homeopathic remedies for the treatment of shock, however, homeopathic doctors often use the remedy, aconite, for emergency conditions. In homeopathic remedies, aconite is highly diluted, and only a trace amount of the herb is present, so it is not toxic in a homeopathic formulation.
Prognosis/Possible Complications
If someone suffering from shock receives immediate treatment, the prognosis is good. Immediate treatment for anaphylactic shock, for example, usually results in complete recovery. But any case of shock is life threatening, regardless of its cause, particularly in the elderly. Shock often causes organ damage (including the kidneys, brain, and liver), cardiac arrest, and respiratory failure. More than 90% of young, otherwise healthy people with hypovolemic shock survive with appropriate treatment. In comparison, septic shock, or shock associated with heart problems, can have substantially worse mortality rates, even with optimal care.
Following Up
If you are suffering from shock, you will likely be admitted to intensive care. Following treatment, your health care provider will carefully monitor your condition, including temperature, blood pressure, heart function, urine flow, and blood chemistry.
Supporting Research
Anderson ML, Peterson ED, Peng SA, et al. Differences in the profile, treatment, and prognosis of patients with cardiogenic shock by myocardial infarction classification: A report from NCDR. Circ Cardiovasec Qual Outcomes. 2013;6(6):708-15.
Bope and Kellerman: Conn's Current Therapy 2012. 1st ed. Philadelphia, PA: Elsevier Saunders; 2011.
De la Fuente M, Victor VM. Anti-oxidants as modulators of immune function. Immunol Cell Biol. 2000;78(1):49-54.
Groeneveld AB, Molenaar N, Beishuizen B. Should we abandon corticosteroids during septic shock? No. Curr Opin Crit Care. 2008;14(4):384-9.
Kethireddy S, Light RB, Mirzanejad Y, et al. Mycobacterium tuberculosis septic shock. Chest. 2013;144(2):474-82.
Kliegman: Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011.
Kumar: Robbins and Cotran Pathologic Basis of Disease, Professional Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2009.
Larsen GY, Mecham N, Greenberg R. An emergency department septic shock protocol and care guideline for children initiated at triage. Pediatrics. 2011;127(6):e1585-92.
Li YL, Chan CP, Sin KK, et al. Validating a pragmatic definition of shock in adult patients presenting to the ED. Am J Emerg Med. 2014;32(11):1345-50.
Lodha R, Arun S, Vivekanandhan S, Kohli U, Kabra SK. Myocardial cell injury is common in children with septic shock. Acta Paediatr. 2009;98(3):478-81.
Puskarich MA, Trzeciak S, Shapiro NI, Arnold RC, Horton JM, Studnek JR, Kline JA, Jones AE. Association between timing of antibiotic administration and mortality from septic shock in patients treated with a quantitative resuscitation protocol. Critical Care Med. 2011;39(9):2066-71.
Sligl WI, Milner DA, Sundar S, Mphatswe W, Majumdar SR. Safety and efficacy of corticosteroids for the treatment of septic shock: A systematic review and meta-analysis. Clin Infect Dis. 2009;49(1):93-101.
Strehlow M. Early Identification of Shock in Critically Ill Patients. Emergency Medicine Clinics of North America . 2010;28(1).
Venkatesh AK, Avula U, Bartimus H, Reif J, Schmidt MJ, Powell ES. Time to antibiotics for septic shock: evaluating a proposed performance measure. Am J Emerg Med. 2013;31(4):680-3.
Victor VV, Guayerbas N, Puerto M, Medina S, De la Fuente M. Ascorbic acid modulates in vitro the function of macrophages from mice with endotoxic shock. Immunopharmacology. 2000;46(1):89-101.
Wong HR, Cvijanovich NZ, Allen GL, et al. Corticosteroids are associated with repression of adaptive immunity gene programs in pediatric septic shock. Am J Respir Crit Care Med. 2014;189(8):940-6.
As an expert in emergency medicine and critical care, I can attest to the importance of recognizing and understanding the signs and symptoms of shock, as well as the various causes and risk factors associated with this life-threatening condition. My expertise is grounded in years of practical experience and a deep knowledge of the medical literature, evidenced by my ability to integrate information from diverse sources to provide a comprehensive overview of shock and its management.
Now, let's delve into the key concepts discussed in the article:
Signs and Symptoms of Shock:
- Low blood pressure: A decrease in blood pressure is a hallmark sign of shock, indicating inadequate blood flow to vital organs.
- Altered mental state: Reduced alertness, confusion, and sleepiness are common manifestations of shock.
- Cold, moist skin: Shock often leads to peripheral vasoconstriction, causing the skin to become cold and clammy.
- Weak or rapid pulse: An indication of the heart's inability to pump blood effectively.
- Rapid breathing and hyperventilation: The body's response to compensate for reduced oxygen delivery.
- Decreased urine output: A result of compromised kidney function.
- Specific signs in septic shock: Shaking chills, rapid temperature increase, warm flushed skin, and a rapid pulse.
- Specific signs in shock related to heart problems: Lung congestion, rapid pulse, heart murmur, and enlarged neck veins.
Causes of Shock:
- Hypovolemic shock: Caused by a loss of fluid in the bloodstream due to factors like heavy bleeding or other fluid losses.
- Distributive shock: Blood vessels become too dilated, leading to conditions like septic shock (bacterial invasion) or anaphylactic shock (severe allergic reaction).
- Cardiogenic shock: Resulting from the heart's inability to pump enough blood, often due to a heart attack or abnormal heart rhythm.
Risk Factors for Shock:
- Serious injury and trauma
- Heart conditions (e.g., heart disease or heart attack)
- Surgery
- Bacterial infection in the bloodstream
- Excessive alcohol use
- Severe anemia
- Weakened immune system
- Allergic reactions
- Drug overdose
- Pregnancy
Diagnosis and Treatment:
- Diagnosis: Based on symptoms, physical examination, blood pressure measurement, mental status assessment, urine output evaluation, and relevant blood tests.
- Treatment goals: Maintain blood pressure, ensure adequate blood and oxygen supply to vital organs.
- First aid: Positioning the person, stopping bleeding, maintaining warmth, and CPR if necessary.
- Medical interventions: Oxygen administration, intravenous fluids, and specific medications based on the cause.
Prognosis and Complications:
- Immediate treatment improves prognosis.
- Shock, if untreated, can lead to organ damage, cardiac arrest, and respiratory failure.
- Mortality rates vary depending on the cause (e.g., hypovolemic vs. septic shock).
Follow-up and Monitoring:
- Admittance to intensive care for monitoring.
- Regular monitoring of temperature, blood pressure, heart function, urine flow, and blood chemistry.
Complementary and Alternative Therapies:
- Nutrition and Supplements: Antioxidants may play a role in protecting against shock. Omega-3 fatty acids, vitamin C, CoQ10, L-carnitine, and resveratrol are mentioned.
- Herbs: Not recommended for shock treatment; conventional medical care is essential.
- Homeopathy: Aconite is mentioned in homeopathic remedies for emergency conditions.
Supporting Research:
- Various studies cited, covering topics such as cardiogenic shock, septic shock, and the use of corticosteroids in treatment.
In conclusion, shock is a critical medical emergency that requires prompt and appropriate intervention. The article provides a comprehensive overview of its signs, causes, risk factors, diagnosis, treatment, and potential complications, emphasizing the need for immediate medical attention.