Shock is a dangerous state in which there is a lack of blood flow and oxygen reaching the body tissues. It can be caused by a variety of conditions, including internal bleeding, infection, heart attack, and trauma.
In this article, we will provide a medical overview of shock, including its causes, symptoms, and treatment options.
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What is Shock?
Shock is a condition in which perfusion to the tissues and vital organs is inadequate to meet metabolic needs. It’s considered to a be a serious condition because life cannot be sustained without adequate blood flow to the tissues of the body.
Therefore, shock requires immediate medical attention as the patient can deteriorate rapidly, and permanent damage to internal organs can occur due to a lack of oxygen.
Types of Shock:
There are several different types of shock, including the following:
- Cardiogenic
- Hypovolemic
- Anaphylactic
- Neurogenic
- Septic
- Vasogenic
- Traumatic
Each type of shock has different causes, symptoms, and treatment options.
Cardiogenic Shock
Cardiogenic shock is a type of shock that occurs when the heart is unable to pump enough blood to meet the body’s needs.
It can be caused by a heart attack, heart failure, or other heart conditions.
Hypovolemic Shock
Hypovolemic shock is a type of shock that occurs when there is a loss of blood or fluid from the body. This can be due to internal bleeding, dehydration, or severe burns.
Anaphylactic Shock
Anaphylactic shock is a type of shock that occurs when the body has an allergic reaction to a medication or food. It can also be caused by insect bites or stings, latex, and blood transfusions.
Neurogenic Shock
Neurogenic shock is a type of shock that occurs when the nervous system is damaged, resulting in irregular blood circulation. It can be caused by spinal cord injury, stroke, or head trauma.
Septic Shock
Septic shock is a type of shock that occurs when there is an infection in the body. It’s a life-threatening condition due to blood pressure dropping to dangerously low levels.
It can be caused by bacterial, viral, or fungal infections.
Vasogenic Shock
Vasogenic shock is a type of shock that occurs when the blood vessels become widened or damaged. As vasodilation occurs, blood pressure decreases, and not enough blood flows to the organs.
It can be caused by inadequate tissue oxygenation, severe hypotension, and certain medications.
Traumatic Shock
Traumatic shock is a type of shock that occurs as the body’s defense mechanism against an emotional or traumatic experience. It is often caused by abuse, illness, divorce, or a life-threatening event.
Sign and Symptoms
The symptoms of shock vary depending on the type of shock. However, there are some common symptoms that occur in all types of shock, including the following:
- Irregular heartbeat
- Rapid, shallow breathing
- Cold, clammy skin
- Fatigue
- Weakness
- Dizziness
- Confusion
- Dilated pupils
- Angina
- Nausea
- Anxiety
- Restlessness
- Decreased urine production
- Dry mouth
- Low blood sugar
- Loss of consciousness
Each patient may experience different symptoms depending on the type of shock, as well as the severity of their condition.
Treatment
The treatment for shock will vary depending on the type of shock and the severity of the patient’s signs and symptoms.
In general, the goal of treatment is to restore blood flow and oxygen to the tissues and organs. This can be done through a variety of methods, including the following:
- Intravenous fluids
- Blood transfusions
- Oxygen therapy
- Cardiopulmonary resuscitation (CPR)
- Mechanical ventilation
- Medications
The type of treatment will also depend on the underlying cause of the shock. For example, if the shock is due to an infection, then the patient will likely be given antibiotics.
If the shock is due to an allergic reaction, then the patient may be given antihistamines or epinephrine.
A patient showing signs and symptoms of shock must seek medical attention immediately. Shock is a medical emergency that can quickly lead to death if not treated promptly.
Shock Practice Questions:
1. What is the definition of
Shock is a syndrome that is characterized by decreased tissue perfusion and cellular metabolism. Cells are not getting what they need, so there is an imbalanced supply of oxygen and what cells need (nutrients). It is a condition in which the circulatory system fails to provide sufficient circulation to enable every body part to perform its function. It is also often called hypoperfusion. Basically, it is a life-threatening state of inadequate tissue perfusion.
2. What are the four primary types of shock?
Hypovolemic, cardiogenic, obstructive, and distributive (anaphylactic, septic, neurogenic).
3. What is perfusion?
It is the passage of fluid through the circulatory system or lymphatic system to an organ or a tissue, usually referring to the delivery of blood to a capillary bed in tissue.
4. What are the components of normal perfusion?
Heart: pump function; blood vessel: container function; and blood: content function.
5. What are the primary causes of shock?
Pump failure, poor vessel function, and low fluid volume.
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6. What are the four distinct stages of shock?
Initial, compensatory, progressive and refractory.
7. What causes anaerobic metabolism in the initial stage of shock?
Hypoperfusion
8. Why does peripheral edema occur in progressive shock?
Because all the fluid your body was trying to preserve during compensation is not being moved around anymore.
9. What is the refractory stage of shock?
Irreversible cell death and organ damage, unresponsive to treatment and death
10. What is cardiogenic shock?
This is caused by inadequate function of the heart or pump failure. The heart muscle cannot pump effectively, causing a backup of fluid, pulmonary edema, and hypotension. There is a decline in cardiac output despite adequate fluid volume that leads to failure of the heart to pump effectively. This is caused by low cardiac output due to reduced preload, high afterload, or poor myocardial contractility
11. What is the main reason for cardiogenic shock?
Myocardial infarction.
12. What does cardiogenic shock cause?
Inadequate heart function, congestive heart failure, myocardial infarction, severe mitral regurgitation, and ventricular tachycardia.
13. What is the treatment for cardiogenic shock?
Keep the patient comfortable, high flow oxygen, assist ventilation ALS, and rapid transport.
14. What pulmonary issue can occur in cardiogenic shock and what can you treat it with?
Pulmonary edema and you can treat it with diuretics.
15. What is obstructive shock?
Obstructive shock is an impairment of the heart to pump effectively as a result of a non-cardiac factor. It is caused by mechanical obstruction which prevents an adequate volume of blood to fill the heart chambers. Two common causes are cardiac tamponade and tension pneumothorax.
16. How can you treat obstructive shock?
Oxygen, keep warm and rapid transport, ALS.
17. What is anaphylactic shock?
18. How do you treat anaphylactic shock?
Advanced airway, high flow oxygen, and if directed epinephrine.
19. What is neurogenic shock?
Trauma-based damage to the cervical spine widespread blood vessel dilation. It is caused by spinal cord damage, typically in the cervical region, which leads to massive vasodilation below the level of injury and relative hypovolemia results due to an increase in vascular space. Neurogenic shock interrupts normal communication pathways between the CNS and
20. What is the primary cause of neurogenic shock?
A spinal cord injury.
21. How can you treat neurogenic shock?
Secure airway, C-spine, high flow O2, assist ventilation, ALS, keep patient warm and prompt transport.
22. What type of shock shows an increased cardiac output, fast capillary refill, and warm and flushed extremities?
Septic shock is the only type that includes these characteristics.
23. What causes septic shock?
It is caused by a severe bacterial infection.
24. How do you treat septic shock?
Fluid resuscitation by administering a minimum of 20 ml/kg crystalloid to maintain 60-65 mmHg MAP. If fluid resuscitation fails, use vasopressor drugs (dopamine, norepinephrine are the first choices). Broad spectrum antibiotics should be administered within 3 hours while waiting on cultures. Fix any altered coagulation problem. This is due to inflammatory response, stimulation of the complement cascade, and reduction in protein C and antithrombin III. The patient should be put on corticosteroids to help with inflammation.
25. How is hypovolemic shock different from cariogenic and septic shock?
Hypovolemic shock has many varied and diverse origins.
26. What are the causes of hypovolemic shock?
Severe dehydration, vomiting, diarrhea (dehydrates you the quickest), burn, diuresis, blood loss, gynecologic, trauma, DKA, surgery (cauterization) and internal fluid collection (peritonitis or ascites).
27. What is often the main cause of hypovolemic shock?
Simple blood loss
28. What amount of fluid loss do patients be at risk of hypovolemic shock?
More than 750 mL of fluid loss, cardiac output begins to fall and vital signs change (subtly).
29. How do you treat hypovolemic shock?
Try to restore the fluid volume and blood pressure.
30. What is the pathophysiology for hypovolemic shock?
Fluid loss causes the autonomic nervous system to initiate fight or flight, norepinephrine and dopamine increase to increase heart rate, vasoconstriction occurs trying to shunt blood to vital organs increased PVR. Patients’ peripheral extremities can be cool and clammy. RAS system attempts to increase BP and CO. A decrease in urine output and increase respirations can be observed.
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31. What happens during the Initial Stage of Shock?
It is usually not clinically apparent, only changes are on a cellular level. The body has been dealing with the imbalance on its own.
32. Which shock depends on fluid resuscitation?
Septic, Hypovolemic, and anaphylactic.
33. What kind of IV is needed for shock patient?
At least 2 large bore IVs with isotonic fluids since the liver is failing and lactated ringers cannot be broken down. Albumin, a fluid expander in the intravascular space, can be given since it won’t cross the membranes.
34. What happens if we give fluid too fast?
There will be signs and symptoms of fluid overload.
35. What is the best thing for hypovolemic shock?
Prevention, monitor ‘leaky’ patients and give fluids, oxygen, and monitor for fluid overload.
36. What is hypovolemic shock?
It is a decrease in intravascular volume of at least 15%-30%. It is a fluid problem, loss of blood can cause this but also dehydration due to vomiting, diarrhea, or burns. Signs and symptoms include trauma/blunt/penetrating, bleeding, altered LOC, nausea/vomiting/diarrhea, and typical signs of shock.
37. What is
It is a pipe (blood vessel) problem, occurs due to widespread vasodilation and increased capillary permeability, which causes blood pooling and relative hypovolemia (low volume relative to the size of vascular space), expands blood vessels making the vascular space bigger and volume inadequate for effective circulation. Different types of distributive shock are anaphylaxis, neurogenic, psychogenic and septic.
38. What is the compensatory stage of shock?
Compensatory stage of shock is when the body is experiencing a state of low blood volume but is still able to maintain cardiac output by increasing the heart rate to restore tissue perfusion and oxygenation. The kidneys hold on to water (decrease urine output) and blood pressure goes up.
39. What happens in the progressive stage of shock?
Compensatory mechanisms fail, blood pressure goes down, heart rate goes down, urine output decreased further and widened pulse pressure.
40. What are expected findings that all shock can cause?
Chest pain, lethargy, somnolence, restlessness, anxiousness, dyspnea, diaphoresis, thirst, muscle weakness, nausea, and constipation.
41. What are the causes of cardiogenic shock?
Myocardial infarction, heart failure, cardiomyopathy, dysrhythmias and heart valve rupture or stenosis.
42. What are the causes of obstructive shock?
Blockage of the great vessels, pulmonary artery stenosis, pulmonary embolism, cardiac tamponade, tension pneumothorax and aortic dissection.
43. What are the three subtypes of distributive shock?
Neurogenic, septic and anaphylactic.
44. Describe neurogenic shock?
Loss of sympathetic tone causing massive vasodilation due to a sympathetic response.
45. What are the causes of neurogenic shock?
Head trauma, spinal cord injury and epidural anesthesia.
46. Describe septic shock?
Exotoxins and other mediators causing massive vasodilation. It is caused by severe infection, which damages blood vessels and increases plasma loss out of the vascular space. Vessels do not constrict well during septic shock, diminishing ability to compensate that leads to relative hypovolemia due to
47. What vital signs can be observed with septic shock?
Increased temperature, increased respiratory rate, hypotension, and tachycardia.
48. What is the most common cause of septic shock?
Gram-negative bacteria.
49. What is the pathophysiology of shock?
Shock is poor perfusion (hypoperfusion) and inadequate tissue perfusion. Cells in the body do not get the oxygen and nutrients they need from the circulatory system.
50. What are the stages of shock?
Compensated shock, decompensated shock, and irreversible shock.
51. What is compensated shock?
It is the early stage of shock. The body is still able to compensate at this point for the hypovolemic state through defense mechanisms like tachycardia and peripheral vasoconstriction.
52. What is decompensated shock?
It is the Late or progressive stage of shock. The body can no longer compensate for the hypovolemic state, so blood pressure starts to fall.
53. What is irreversible shock?
The final stage of shock where the patient will not survive and systems start slowing down.
54. What are the early signs of shock (compensated)?
Cold, clammy hands and feet; pale or blue-tinged skin tone; weak, fast pulse rate; fast rate of breathing; and narrowing pulse pressure.
55. What are the late signs of shock (decompensated)?
Falling blood pressure (systolic of 90 mm Hg or lower with adults), weak, thread or absent peripheral pulses, ashy or cyanotic pallor, decreased mental
56. What are the three causes of shock?
Pump (heart problems): MI, cardiac trauma; Pipe (blood vessels): anaphylaxis, spinal trauma, infection; and, Fluid (blood volume): bleeding, vomiting, diarrhea.
57. What are the compensation mechanisms?
Tachycardia, peripheral vasoconstriction (will constrict vessels to try and increase blood pressure and increase perfusion to organs), and increased breathing rate.
58. What is one of the most pertinent late signs of shock?
Falling blood pressure.
59. What are the signs and symptoms of cardiogenic shock?
Hypotension, portable cardiac history, chest pain, respiratory distress, pulmonary edema, and altered LOC.
60. What is cardiac tamponade?
Fluid accumulation within the pericardial sac and compresses the heart, also called pericardial tamponade. Signs and symptoms include JVD, narrowing pulse pressure, and hypotension.
61. What is a tension pneumothorax?
Air enters the chest cavity due to injury or sucking chest wound and accumulating pressure compresses the lungs. Signs and symptoms include JVD, respiratory distress, diminished lung sounds, poor compliance with BVM, and tracheal deviation toward the unaffected side (late sign).
62. What is psychogenic shock?
Pseudo-shock caused by sudden, temporary vasodilation that leads to syncope. Psychogenic shock does not inherently present a sustained problem due to inadequate tissue perfusion. Sudden vasodilation interrupts blood flow to the brain, leading to syncope.
63. What are the early signs and symptoms of shock?
Altered LOC (anxiety, irritability), tachycardia, pale/cook skin, weak peripheral pulses, increased respiratory rate, thirst, and delayed capillary refill.
64. What are the late signs and symptoms of shock?
Falling blood pressure, irregular breathing, cyanosis, and absence of peripheral pulses.
65. How do you manage shock?
Control bleeding (if any), put the patient in Trendelenburg position, prevent loss of body heat, and initiate rapid transport.
Final Thoughts
Shock is a medical emergency that can be caused by a variety of conditions. There are several different types of shock that vary in symptoms and treatment options.
Shock can causes breathing problems and respiratory failure, which is why respiratory therapist are involved in the treatment process.
If you want to learn more about the heart, be sure to check out our guide on myocardial infarctions. I think you’ll find it helpful. Thanks for reading!
Written by:
John Landry, BS, RRT
John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.
References
- Faarc, Kacmarek Robert PhD Rrt, et al. Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020.
- Rrt, Des Terry Jardins MEd, and Burton George Md Facp Fccp Faarc. Clinical Manifestations and Assessment of Respiratory Disease. 8th ed., Mosby, 2019.
- “Physiopathology of Shock.” PubMed Central (PMC), Apr. 2011, www.ncbi.nlm.nih.gov/pmc/articles/PMC3132363.
- “The Nomenclature, Definition and Distinction of Types of Shock.” National Center for Biotechnology Information, Nov. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6323133.
- “Shock – Classification and Pathophysiological Principles of Therapeutics.” PubMed Central (PMC), 1 May 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6520577.