Shock

Shock

Definition
Shock is a life‑threatening state in which the circulation cannot supply enough oxygen to the tissues, leading to cellular injury.

Causes / Etiology

• Severe loss of blood or fluids (hemorrhage, dehydration, burns)
• Cardiac pump failure (myocardial infarction, severe arrhythmia)
• Obstruction of great vessels or heart chambers (tamponade, pulmonary embolism)
• Widespread vasodilation (septic infection, anaphylaxis, neurogenic injury)
• Other factors such as drug overdose or endocrine crisis

Types or Classification
Hypovolemic shock – due to reduced intravascular volume.
Cardiogenic shock – due to failure of the heart to pump effectively.
Obstructive shock – due to mechanical blockage of circulation.
Distributive shock – due to abnormal distribution of blood flow from vasodilation.

Pathology (step‑wise)
Step 1 → loss of volume or pump failure → fall in cardiac output.
Step 2 → fall in arterial pressure → poor tissue perfusion.
Step 3 → inadequate oxygen delivery → cellular hypoxia.
Step 4 → activation of sympathetic nervous system → tachycardia, peripheral vasoconstriction.
Step 5 → if not corrected, metabolic acidosis, organ dysfunction and eventually death.

Clinical Features

General –

• Low blood pressure (systolic < 90 mm Hg)
• Rapid pulse (tachycardia)
• Fast breathing (tachypnea)
• Cold, clammy skin (due to vasoconstriction)
• Decreased urine output (oliguria)
• Restlessness or altered consciousness

Specific –
Hypovolemic: dry mucous membranes, sunken eyes, reduced skin turgor.
Cardiogenic: raised jugular venous pressure, pulmonary crackles, peripheral edema.
Obstructive: distended neck veins, muffled heart sounds (tamponade).
Distributive (septic): fever, warm flushed skin early, later cold skin.

Complications

Acute –

• Acute renal failure, hepatic dysfunction, myocardial ischemia
• Acute respiratory distress syndrome (ARDS)
• Disseminated intravascular coagulation (DIC)

Chronic –

• Persistent organ insufficiency (e.g., chronic kidney disease)
• Post‑traumatic stress disorder (PTSD) after severe shock episode
• Chronic fatigue and reduced exercise tolerance

Diagnosis / Investigations

Routine –

• Non‑invasive blood pressure and pulse monitoring
• Central venous pressure (if line placed)
• Urine output charting

Special –

• Arterial blood gas (ABG) for pH, PaO₂, PaCO₂, lactate
• Serum lactate level (marker of tissue hypoxia)
• Complete blood count, electrolytes, renal and liver function tests
• ECG and chest X‑ray (to look for cardiac or pulmonary causes)
• Echocardiography (to assess cardiac function)
• CT angiography when obstruction suspected (e.g., pulmonary embolism)

Management

General measures –

• Give high‑flow oxygen (≥ 6 L/min) or mask ventilation if needed
• Rapid fluid resuscitation with crystalloids (30 ml/kg) and, if indicated, colloids or blood products
• Position patient supine with legs raised (Trendelenburg) to improve venous return

Modern treatment –

• Early goal‑directed therapy: target MAP ≥ 65 mm Hg, urine output ≥ 0.5 ml/kg/h, ScvO₂ ≥ 70 %
• Use vasopressors (noradrenaline, dopamine) when fluids alone do not restore pressure
• Treat underlying cause promptly (antibiotics for sepsis, surgery for hemorrhage, thrombolysis for embolism)

Dietary advice –

• Small, frequent, protein‑rich meals once stable
• Adequate fluid intake (≈ 2–3 L/day) unless fluid restriction is ordered
• Avoid heavy, fatty meals that may increase metabolic demand

Homeopathic Therapeutics (key remedies, 6‑7 points each)

Aconitum napellus

• Sudden onset of shock after fright or trauma
• Marked anxiety, fear of death
• Restlessness, rapid pulse, dry mouth
• Cold sweat, pale skin
• Burning pain in chest or abdomen
• Better after exposure to fresh air

Carbo vegetabilis

• Weakness, faintness, feeling of collapse
• Cold, clammy skin, bluish lips
• Rapid, weak pulse, low blood pressure
• Profuse sweating, especially on the forehead
• Relief when lying on the back with legs raised
• Useful in shock due to severe blood loss

Glonoinum

• Shock following head injury or severe bruising
• Throbbing headache, feeling of heat in the head
• Pulse very rapid, full and bounding
• Skin hot, dry, flushed
• Aggravated by warm rooms, better in cool air
• Restlessness, desire to be alone

Veratrum album

• Profound prostration, inability to rise
• Nausea, vomiting of bile, epigastric pain
• Cold sweat, cold clammy extremities
• Slow, feeble pulse, low blood pressure
• Drowsiness, mental dullness
• Better when warm blankets are applied

Opium

• Deep stupor, unresponsiveness, semi‑coma state
• Very slow, weak pulse, low blood pressure
• Respiratory rate very slow, shallow breathing
• Dry mouth, constipation, feeling of heaviness
• Cold, clammy skin, no thirst
• Useful when shock is associated with severe pain or narcotic overdose