Shock Overview
A state of tissue hypoxia due to decreased ...
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Description

Shock Overview

A state of tissue hypoxia due to decreased or dysregulated oxygen delivery or extraction, resulting in end-organ damage and often occurring in the setting of hypotension

Shock can develop in the setting of increased tissue demand, decreased O2 supply, or both. While initially reversible, it rapidly progresses: cell death -> end-organ dysfunction -> multiorgan failure -> death

Common Clinical Manifestations

 • Neuro: altered mental status

 • CV: hypotension (SBP < 90 mmHg or decr > 40 mmHg from bl), wide vs. narrow pulse pressure

 • Pulm: resp. alterations (tachypneic / incr MV vs. somnolent/depressed)

 • Renal: metabolic acidosis, oliguria (< 0.5 mL/kg/hr)

 • Ext: warm vs. cold (feel shins and up), dry vs. wet (dependent areas, back of thigh/flank edema)

Distributive Shock - Decreased SVR and altered O2 extraction

 • Inflammatory: infectious (sepsis) or not (pancreatitis. post-arrest)

 • Reactionary: anaphylaxis, toxins/meds

 • Other: AI, thyroid dz liver failure, neurogenic/spinal

Hypovolemic Shock - Low CO and therefore inadequate O2 delivery

 • Hemorrhagic: bleeding out (trauma, GI, post-partum) bleeding in (trauma, hemothorax. RP bleed)

 • Hypovolemic: GI (vomiting/diarrhea), renal (over-diuresis, dialysis/CRRT, post-ATN, post-obstructive polyuria), surgical (burns, open abdomen/wound. drains)

Cardiogenic Shock - Low CO and therefore inadequate O2 delivery

 • MI, Heart Failure, Severe Valve Dz, Myocarditis, Arrhythmias

Obstructive Shock - Low CO and therefore inadequate O2 delivery

 • PE, Tension ptx, Tamponade



Dr. Meredith Greer @EmmGeezee



#Shock #Classification #diagnosis #management #Overview #criticalcare #differential #causes #classification
Contributed by

Dr. Gerald Diaz
@GeraldMD
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief 🇵🇭 🇺🇸 - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG:  https://www.instagram.com/grepmed/ | Twitter: https://twitter.com/grepmeded/
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