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Shock: causes, warning signs, first aid

by Josephine Andrews
Published: Last Updated on 383 views

Medical shock is a severe circulatory disorder characterized by insufficient oxygen supply: the oxygen supply cannot cover the oxygen demand. Then only the vital organs are sufficiently supplied with blood and thus oxygen – at the expense of the periphery (limbs). If the lack of oxygen continues to worsen, the organs will eventually no longer receive sufficient oxygen – there is a risk of death! Read everything you need to know about shock here!

quick overview

  • what is a shock A life-threatening circulatory disorder in which not enough oxygen can reach all parts of the body. In the organs, there is an imbalance between the need and supply of oxygen, which ultimately causes them to fail.
  • Types of shock : Depending on the trigger, a distinction is made between hypovolemic, cardiogenic, obstructive and distributive shock. The latter form of shock includes neurogenic, anaphylactic and septic shock.
  • Causes : in the case of hypovolemic shock, eg severe blood loss, lack of fluids (eg in the case of severe diarrhea); in cardiogenic shock eg heart attack, ventricular fibrillation; in the case of obstructive shock, e.g. acute diseases of the lungs or the occlusion of large vessels; in anaphylactic shock, allergens such as insect venom; a septic shock is based on infections, the neurogenic shock, for example, on cerebral hemorrhage or a stroke
  • Symptoms : restlessness, anxiety, paleness, tremors, chills, chills, cold sweats. For some forms of shock: warm, reddened skin . With advanced shock: apathy, unconsciousness.
  • First-aid measures : Call the emergency services immediately (severe danger to life!). Until this arrives: shock position with legs elevated (except in the case of cardiogenic shock or injuries to or in the upper body and head: raise the upper body in this case), calm the patient down and cover them up, check consciousness, breathing and pulse, if necessary, lie on one side, heart massage and mouth -to-mouth resuscitation.
  • Treatment : After the immediate measures, further treatment depending on the type of shock, eg medication or infusions to increase the blood volume, blood supplies, painkillers, oxygen supply, medication to increase the contraction force of the heart, antiallergics, antibiotics.

Shock: description

In the event of a shock, the blood circulation in the body is usually massively disrupted. As a result, the organs lack the oxygen that is transported there via the blood. This mismatch between oxygen demand and oxygen supply is life-threatening. It damages the organs and disrupts important metabolic processes.

The shock – a vicious circle

In the context of a shock, the body starts a kind of emergency program, the so-called ” centralization” : The vessels in the body’s periphery, i.e. in the arms and legs, narrow so that less blood can circulate there. The blood volume consequently shifts to the center of the body. This means that more blood is available for the internal organs and the brain .

The centralization seems to make sense – but only at first glance! This is because the metabolism changes in the low-perfusion, low-oxygen body periphery, resulting in the formation of acidic metabolites.

These cause the arterioles (small vessels that carry blood and oxygen to the tissue) to dilate. Their counterparts, the venules, do not dilate. As a result, they cannot completely remove the “used” blood from the tissue – blood builds up ( microcirculation disorder ). Small blood clots ( microthrombi ) form in it.

In addition, more fluid flows from the smallest vessels ( capillaries that lie between the arterioles and venules) into the tissue. As a result, the circulating blood volume continues to fall and the tissue is even less well supplied with oxygen – a vicious circle that doctors call a shock spiral .

If left untreated, this spiral keeps turning , with increasingly fatal consequences. In extreme cases, the formation of microthrombi can use up important substances in the blood that are responsible for blood clotting ( consumptive coagulopathy ). This can cause bleeding in the body. Eventually, over time, vital organs are no longer adequately supplied with blood or oxygen. Then the cycle breaks down, resulting in multiple organ failure.

Few people survive multiple organ failure. It is therefore important to intervene as early as possible in the event of a shock.

Depending on the triggering cause, a distinction is made between different types of shock:

Hypovolemic Shock

Hypovolemic or volume deficiency shock is triggered by severe fluid loss , for example after severe internal or external bleeding (hemorrhagic shock), severe diarrhea or vomiting . There are three stages:

  • Stage 1: The blood pressure is normal, the skin appears pale and damp and cool.
  • Stage 2 : Blood pressure drops (below 100 mmHg systolic), pulse increases to more than 100 beats per minute.
  • Stage 3 : The blood pressure continues to fall (below 60 mmHg), the pulse becomes flatter and can hardly be felt. There are also disturbances of consciousness, urinary retention and shallow, rapid breathing.

cardiogenic shock

Cardiogenic shock originates in the heart . If this is damaged as a result of a heart attack, for example, it lacks the strength to pump enough blood into the circulatory system. Then, after a while, the spiral of shock sets in.

obstructive shock

If the heart itself or large blood vessels are compressed, misplaced or blocked, this affects the work of the heart and the circulatory system. There is a risk of a so-called obstructive shock (obstruction describes the said closure or narrowing).

In the past, obstructive shock was considered to be cardiogenic and its appearance can hardly be distinguished from it. However, doctors here treat it fundamentally differently, so that it is now considered a separate form of shock.

distributive shock

In a distributive shock, the distribution of blood is disturbed. The vessels widen or can no longer narrow as a result of pathological processes. The blood volume shifts as a result and fluid usually leaks out of the vessels into the surrounding tissue. As a result, there is a lack of blood and therefore oxygen within the vascular system and consequently in important parts of the body.

Distributive shock is divided into three groups: anaphylactic shock, neurogenic shock and septic shock.

Anaphylactic shock

In this case, the shock is due to an extremely exaggerated allergic reaction of the immune system: In the case of an allergy, the immune system mistakenly interprets certain substances (allergens) in foods, medicines or insect venom as dangerous. When it comes into contact with these substances, it therefore releases messenger substances that dilate the blood vessels and allow liquid to escape from the capillaries. This causes the blood volume to drop and the shock spiral begins to turn.

Septic shock

The trigger of septic shock is a local or whole-body infection . As with anaphylactic shock, messenger substances (mediators) are also released here, which dilate the blood vessels and allow fluid to leak into the tissue. A special form of septic shock is toxic shock syndrome (TSS) : Here the immune system reacts to toxins produced by invading bacteria.

neurogenic shock

A part of the nervous system fails, so that the blood vessels can no longer narrow and the circulatory system collapses. Liquid can also leak out in an uncontrolled manner.

Special case hypoglycemic shock

If the sugar concentration in the blood falls below a critical limit (about 50 mg/dl), sudden unconsciousness occurs because the brain is no longer supplied with the energy supplier.

This is not a classic shock. Losing consciousness due to severe low blood sugar (hypoglycemia) appears like one. However, the condition is not due to a lack of oxygen as part of a disturbed circulatory system.

Shock: Symptoms

Important signs of shock include:

  • Skin changes: pale, cold-sweaty skin in hypovolemic and cardiogenic shock; red, hot skin in septic shock; pale, warm, dry skin in neurogenic shock; allergic skin symptoms in anaphylactic shock (redness, overheating, itching, possibly swelling)
  • drop in blood pressure
  • Rapid heartbeat (tachycardia), exception: in the case of neurogenic shock and certain cardiac arrhythmias, the heartbeat is significantly slower (bradycardia).
  • barely palpable pulse
  • accelerated breathing, subjectively difficult breathing
  • Restlessness, nervousness, anxiety, tremors
  • Disorders of consciousness in advanced shock, eg listlessness (apathy), loss of consciousness

In children, an inexplicable tachycardia is often the earliest symptom of shock. A drop in blood pressure and breathing disorders, on the other hand, usually only occur later.

Shock: causes

Depending on the type of shock, there are different causes. Important: These causes do not always result in a shock!

Causes of hypovolemic shock

Hypovolemic shock is due to excessive blood loss from the vessels. Possible triggers are:

  • Heavy bleeding , e.g. after injuries to vessels or organs, with broken bones, operations or childbirth (heavy post-operative bleeding), reduced blood clotting due to diseases (hemophilia) or blood-thinning medication (e.g. coumarins, heparin)
  • Fluid deficit , for example due to prolonged vomiting or severe diarrhea. If you drink too little over a long period of time, your blood volume can drop dangerously.

Causes of cardiogenic shock

If the heart is too weak to pump enough blood into the circulatory system, cardiogenic shock can result. Reasons for insufficient cardiac output are, for example:

  • Weakness of contraction of the heart, for example due to a heart attack, heart muscle inflammation or malformations of the heart muscle. The heart then cannot contract properly and therefore cannot generate enough pressure in the blood vessels.
  • Oversupply of blood , for example when a heart valve does not close properly. During the filling phase, blood then flows back from the aorta or the lungs into the corresponding heart chamber and fills it excessively.
  • Heart valve narrowing (such as aortic valve stenosis ): Here the heart has to pump against increased resistance. The high pressure loads damage the heart muscle, while at the same time less blood gets into the vessels due to the smaller diameter of the valve opening.

Causes of obstructive shock

Narrowed or clogged large blood vessels disrupt circulation and impede heart function. The heart itself can also be affected by such an obstruction. Causes of this type of shock include:

  • Injuries or diseases of the lungs that impede venous return to the heart, such as a pneumothorax. In the case of a pulmonary embolism , the blood can back up in the heart and put a strain on it.
  • Constriction of the heart due to an effusion or bleeding (cardiac tamponade) in the sac around the heart (pericardium). This can also narrow due to inflammation (constrictive pericarditis). The chambers of the heart can then no longer fill up sufficiently, which reduces the pumping capacity of the heart.
  • Narrowing of vessels , for example due to tumors, but also due to pregnancy (e.g. vena cava syndrome ).
  • Bleeding into the wall of the main artery splits it accordingly (aortic dissection). This not only constricts the artery, but also blocks the flow of blood into outgoing vessels that lead to important organs.
  • Pronounced arteriosclerosis of the large vessels , with subsequent vascular occlusion, approximately where the main artery divides into the two iliac arteries (aortic bifurcation/Leriche syndrome).

Causes of allergic shock

An excessive reaction of the immune system is to blame for the allergic (anaphylactic) shock . The triggers are individual allergens, i.e. substances to which the affected person has an allergic reaction, for example:

  • Insecticide (bee or wasp venom)
  • Foods such as nuts, stone fruit or strawberries
  • Medicines, e.g. painkillers, anesthetics or antibiotics (especially penicillins)

Causes of septic shock

Septic shock is caused by an infection (eg, bacterial or fungal). This can be localized or affect the entire body. The following factors can cause septic shock:

  • Inflammation : inflammation of the peritoneum (peritonitis), inflammation of the pancreas (pancreatitis), inflammation of the gallbladder (cholecystitis), inflammation of the kidneys (pyelonephritis) or inflammation of the lungs (pneumonia).
  • Catheters (venous catheters, urine catheters, etc.): Pathogens can enter the body via them and cause sepsis, in the worst case with shock.
  • severe, extensive burns : the wounds can become infected up to the point of septic shock.
  • weakened immune system : It favors septic shock.

Septic shock is particularly dangerous

  • caused by meningococci (pathogens that cause meningitis),
  • which occurs as part of a Waterhouse-Friderichsen syndrome (acute failure of the adrenal glands) or
  • which occurs in people who have had their spleen removed.

Causes of neurogenic shock

In a neurogenic shock, those parts of the nervous system that regulate the circulatory system (control of the work of the heart and vascular muscles) are disrupted. Causative diseases include:

  • traumatic brain injury
  • cerebral hemorrhage
  • stroke
  • spinal cord injuries

First aid for shock

If you suspect shock , call the emergency services immediately ! Until he arrives, you should definitely provide first aid:

  • If the victim (adult or child) is conscious, place them in the shock position . To do this, lay him flat, but keep your legs higher than your upper body. This allows blood to flow more easily to the heart. For example, place a bag under the victim’s knees.

If cardiogenic shock is suspected, however, the upper body must be positioned higher so that the heart is not put under additional strain. The shock position is also unfavorable for injuries in the upper body and head area (increased blood circulation then worsens the situation).

  • Avoid any additional excitement for the person concerned. If necessary and possible, shield him a little.
  • Calm the victim down.
  • Keep the patient warm with a thermal blanket or wrap to prevent chilling from shock.
  • Stop existing bleeding to avoid further blood loss.
  • Check the victim’s consciousness: speak to them and gently shake their shoulder.
  • If the patient does not respond, check breathing and pulse. Place your ear over the patient’s mouth and nose and listen for breathing sounds. If he is breathing on his own, place him in the recovery position. If he is not breathing or is breathing insufficiently, begin CPR.
  • It is essential that you stay with the person concerned and check their breathing and pulse regularly until the emergency doctor arrives and treats the shock.

A person in shock should not eat, drink or smoke. Stop the person concerned if you suspect shock!

Shock: diagnosis and treatment

The first thing to do is to recognize a shock as such. For this it is important to inform the (emergency) doctor about previous, relevant events: For example, did the person concerned eat something special shortly beforehand, was he bitten by an insect or is a heart disease known? Was there an accident, an operation or an infection in the recent past? These are important questions that can help the doctor make a diagnosis. The typical shock symptoms (see above) provide further information.

In addition, a shock can be quickly recognized by various signs:

  • Shock Index : It is an important indicator. The pulse rate is divided by the systolic blood pressure value (the first value when measuring blood pressure). If the result is greater than 1 (i.e. the heart rate exceeds the blood pressure), this indicates a shock. In the early phase of a shock, however, the value can still be less than 1.
  • Fingernail test : This involves squeezing a fingernail until the underlying nail bed is bloodless and white. Shortly after letting go, the nail bed should turn red again. If this lasts longer than a second, this indicates a disturbed peripheral blood flow and thus a shock.
  • Sunken veins in the neck (jugular veins) and veins in the floor of the tongue are typical signs of hypovolemic shock.

In addition, the following examinations are carried out if shock is suspected:

  • Electrocardiography ( ECG )
  • Measurement of central venous pressure
  • Measuring the amount of urine produced (diuresis)
  • Determination of various blood values ​​(such as oxygen saturation )

shock therapy

After the first aid measures described above, the attending physician will initiate appropriate treatment depending on the cause of the shock. Some examples:

  • Hypovolemic shock : Here, in particular, the lost blood volume must be replaced. This is done with the help of so-called isotonic crystalline (saline or glucose) and colloidal infusion solutions, i.e. blood volume-increasing solutions with macromolecules such as carbohydrates (hydroxyethyl starch, dextrans) or proteins (gelatine or human albumin ). If necessary, the patient also receives blood supplies.
  • Cardiogenic shock : It is treated with pain relievers and drugs that increase the ability of the heart to contract (dobutamine) as needed. In addition, oxygen is supplied to improve the supply of tissue and heart muscle. In the event of a heart attack, doctors will try to unblock the blocked coronary artery.
  • Anaphylactic shock : The patient is given medication to counteract the overreaction of the immune system (glucocorticoids, antihistamines). There are also active ingredients that constrict the dilated blood vessels ( adrenaline ) and expand the cramped bronchi (beta-2 mimetics). A volume replacement may also be necessary here.
  • Septic shock : The triggering pathogens are combated with suitable medication (eg antibiotics against bacteria). In addition, patients often need volume replacement and, if necessary, vasoconstricting medication to overcome the shock .

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