Shock: Difference between revisions

Jump to navigation Jump to search
No edit summary
 
(15 intermediate revisions by 4 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{| class="infobox" style="float: right;"
| style="vertical-align: middle; padding: 5px;" align=center | [[File:Siren.gif|30px|link=Shock resident survival guide]]
| style="vertical-align: middle; padding: 5px;" align=center | [[Shock resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
|}
'''For patient information, click [[Shock (patient information)|here]].'''
{{CMG}}
{{Shock}}
{{Shock}}
{{CMG}}


==Clinical Recognition==
==[[Shock overview|Overview]]==
End-organ hypoperfusion affects virtually all body systems and can manifest in several clinically detectable ways:
 
==[[Shock historical perspective|Historical Perspective]]==
 
==[[Shock classification|Classification]]==
 
==[[Shock pathophysiology|Pathophysiology]]==
 
==[[Shock causes|Causes]]==
 
==[[Shock differential diagnosis|Differentiating Shock from other Diseases]]==
 
==[[Shock epidemiology and demographics|Epidemiology and Demographics]]==
 
==[[Shock risk factors|Risk Factors]]==
 
==[[Shock screening|Screening]]==
 
==[[Shock natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
 
==Diagnosis==
 
[[Shock history and symptoms|History and Symptoms]]  | [[Shock physical examination|Physical Examination]] | [[Shock laboratory findings|Laboratory Findings]] | [[Shock electrocardiogram|Electrocardiogram]] | [[Shock chest x ray|Chest X Ray]] | [[Shock CT|CT]] | [[Shock MRI|MRI]] | [[Shock echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Shock other imaging findings|Other Imaging Findings]] | [[Shock other diagnostic studies|Other Diagnostic Studies]]


The values given are approximate and certain special considerations should be borne in mind. For instance, patients on [[:Category:Betablockers|&beta;-blockers]] may not be able to mount a significant [[tachycardia]]. A normal pulse rate is seen in some cases of shock, a phenomenon sometimes confusingly described as relative [[bradycardia]].<ref>Demetriades D, Chan LS, Bhasin P, Berne TV, Ramicone E, Huicochea F, et al. Relative bradycardia in patients with traumatic hypotension. The Journal of trauma. 1998;45:534-9. PMID 9751546</ref> Paradoxical (absolute) bradycardia is also described. Compensatory mechanisms in the elderly can also be less pronounced and so the typical pattern above may not be seen. Also, young, very fit patients may be able to compensate so well that physiological derangements only manifest when the shock is very severe and sudden decompensation occurs.
==Treatment==


==Signs and symptoms==
[[Shock medical therapy|Medical Therapy]] | [[Shock surgery|Surgery]] | [[Shock primary prevention|Primary Prevention]] | [[Shock secondary prevention|Secondary Prevention]] | [[Shock cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Shock future or investigational therapies|Future or Investigational Therapies]]
*'''Hypovolemic shock'''
**Anxiety, restlessness, [[Glasgow Coma Scale|altered mental state]] due to decreased cerebral perfusion and subsequent hypoxia.
**Hypotension due to decrease in circulatory volume.
**A rapid, weak, thready pulse due to decreased blood flow combined with tachycardia.
**Cool, clammy skin due to vasoconstriction and stimulation of vasoconstriction.
**Rapid and shallow respirations due to sympathetic nervous system stimulation and acidosis.
**Hypothermia due to decreased perfusion and evaporation of sweat.
**Thirst and dry mouth, due to fluid depletion.
**Fatigue due to inadequate oxygenation.
**Cold and mottled skin ([[cutis marmorata]]), especially extremities, due to insufficient perfusion of the skin.
**Distracted look in the eyes or staring into space, often with pupils dilated.
*'''Cardiogenic shock''', similar to hypovolaemic shock but in addition:
**Distended [[jugular vein]]s due to increased [[jugular venous pressure]].
**Absent pulse due to tachy[[arrhythmia]].
*'''Obstructive shock''', similar to hypovolaemic shock but in addition:
**Distended [[jugular vein]]s due to increased jugular venous pressure.
**[[Pulsus paradoxus]] in case of tamponade
*'''Septic shock''', similar to hypovolaemic shock except in the first stages:
**Pyrexia and fever, or [[hyperthermia]], due to overwhelming bacterial infection.
**Vasodilation and increased [[cardiac output]] due to [[sepsis]].
*'''Neurogenic shock''', similar to hypovolaemic shock except in the skin's characteristics. In neurogenic shock, the skin is warm and dry.
*'''Anaphylactic shock'''
**Skin eruptions and large welts.
**Localised [[edema]], especially around the face.
**Weak and rapid pulse.
**Breathlessness and cough due to [[bronchospasm|narrowing of airways]] and [[edema|swelling of the throat]].


==Case Studies==


[[Shock case study one|Case #1]]


==Related Chapters==
==Related Chapters==
* [[Obstructive shock]]
* [[Obstructive shock]]
* [[Cardiogenic shock]]
* [[Cardiogenic shock]]
*[[Acute respiratory distress syndrome]] (ARDS)
* [[Acute respiratory distress syndrome]] (ARDS)
*[[Military Anti-Shock Trousers]]
* [[Military Anti-Shock Trousers]]
*[[Physical trauma]]
* [[Physical trauma]]
*[[Sepsis]]
* [[Sepsis]]
*[[Stress (medicine)]]
* [[Stress (medicine)]]
*[[Systemic inflammatory response syndrome]] (SIRS)
* [[Systemic inflammatory response syndrome]] (SIRS)
 
==References==
 
{{Reflist|2}}


{{General symptoms and signs}}
{{General symptoms and signs}}
[[bs:Šok (medicina)]]
[[cs:Šok]]
[[da:Shock]]
[[de:Schock (Medizin)]]
[[el:Καταπληξία]]
[[es:Choque (medicina)]]
[[fr:Collapsus]]
[[gl:Shock]]
[[id:Shock]]
[[it:Shock]]
[[he:הלם]]
[[lt:Šokas]]
[[nl:Shock]]
[[ja:ショック]]
[[no:Sjokk]]
[[pl:Wstrząs]]
[[pt:Choque circulatório]]
[[ro:Şoc]]
[[ru:Травматический шок]]
[[simple:Shock]]
[[sr:Шок]]
[[fi:Šokki]]
[[sv:Chock]]
[[tr:Şok]]
[[zh:休克]]
----
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}


[[Category:Medical emergencies]]
[[Category:Medical emergencies]]

Latest revision as of 18:17, 12 May 2014

Resident
Survival
Guide

For patient information, click here.


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Shock Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Shock from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Shock On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Shock

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Shock

CDC on Shock

Shock in the news

Blogs on Shock

Directions to Hospitals Treating Shock

Risk calculators and risk factors for Shock

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Shock from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | Chest X Ray | CT | MRI | Echocardiography or Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

Related Chapters

Template:General symptoms and signs