Shock is simply the body’s inability to meet its metabolic demands.
In plain English, it is the lack of blood flow to important organs limiting the delivery of oxygen, fuel, and nutrients. If not reversed, death occurs.
Though all shock does limit blood flow and causes low blood pressure, there are five different forms of shock.
Cardiogenic shock is due to problems with the heart, or the pump of the circulatory system.
These problems could be due to a heart attack causing damage to the heart muscle, valve obstructions limiting outflow of blood or leaky valves lowering pressure.
Or heart failure whereby the heart can’t generate sufficient forces necessary to maintain circulation, or even infection of the heart muscle. This can be difficult to correct.
Hypovolemic (or low volume) shock is due to there not being enough blood to support a normal blood pressure. It is usually reversible with IV fluids or a blood transfusion.
Anaphylactic shock is caused by an overwhelming histamine release causing vasodilatation or the relaxation of blood vessels resulting in a drop in blood pressure.
This may be reversed with epinephrine, steroids, antihistamines, and IV fluids. There are two kinds of antihistamines – H1 and H2 blockers.
H1 are what we traditionally think of as antihistamines like Benadryl, Zyrtec, Claritin, Atarax, and the like.
H2 blockers are what we usually think of as treatment for gastric reflux, but can still help in an anaphylactic reaction.
They are medications like Zantac, Tagamet, Pepcid, and Axid. However, the first-line drug of choice is always epinephrine.
Toxins (like LPS) released by bacteria that are causing an overwhelming infection cause septic shock.
Septic shock is responsible for up to 1/3 of deaths in the hospital. Treatment includes IV fluids and antibiotics.
Neurogenic shock is the final type and is due to neurologic damage. It may be caused by trauma and spinal cord injury and is treated with supportive care including IV fluids.
There are three phases of shock.
The first is compensated shock and is the stage where the body, despite changes like a faster heart rate and shunting of blood to important organs through shutting down circulation to less important areas, can temporarily manage the issues causing the shock thereby preserving circulation to the brain, lungs, kidneys, and liver.
If not reversed, this may progress to the second stage or non-compensated reversible shock that occurs when the body can no longer maintain an adequate blood pressure.
If not corrected, this may progress to Stage 3 or irreversible shock in which organs begin to fail and cellular death occurs.
So how do you manage shock?
There are many variables depending on the type of shock, but in general, there is one common element – increasing blood volume and improving circulation through stopping any bleeding, and then either administering IV fluids or aggressive oral rehydration.
Secondly, if the individual in shock has severe or known allergies, assure that they always have an EpiPen available. Don’t be scared to use it. If there is any doubt, give epi.
Finally, if due to an infection, give antibiotics.
Of course, if a person is having a heart attack, give aspirin and consider nitroglycerin unless the patient has recently used Viagra, Cialis, or Levitra. In that situation, the nitroglycerine could drop the blood pressure too low and the patient could die.
The most important part of managing shock effectively is to get the patient to a higher level of medical care as quickly as possible.
It is difficult if not impossible to reverse most shock without trained medical intervention. What you can do is buy time to get someone from where they are to a higher level of care.
