Shock

Def: Shock is an acute haemodynamic disorder with insufficient oxygen supply to tissues and organs in relation to demand.

Cardiogenic shock:

Reduction of cardiac output by decreasing the cardiac output of the heart

(mostly in the context of a heart attack, rhythm disturbances or pulmonary embolism)

Symptoms:

General shock signs such as paleness, acrocyanosis, cold sweat, dyspnea, restlessness, anxiety, clouding of consciousness, optional pulmonary edema, influence congestion, RR < 90 mmHg, tachycardia

In cases of cardiogenic shock as a result of myocardial infarction, PTCA is the primary target. This brings better therapeutic results than lysis. Catecholamines (adrenalin, dopamine, dobutamine, arterenol) are available via perfusor to stabilize the patient.

Traumatic Shock

Combination of hypovolemia (bleeding) and soft tissue injury (pain, mediator release)

The extent of a traumatic shock can be estimated from:

Anamnesis (accident history - impact of forces)

Injury pattern (varying blood loss depending on localization of fractures)

Clinical signs: anxiety, restlessness, confusion, acrocyanosis, sweating, dyspnea, tachypnea

Blood pressure and pulse

Anaphylactic shock

Hypovolemia caused by allergic reaction (peripheral vasodilatation and increased vascular permeability) with varying degrees of severity:

Grade 1: Urticaria, Flush

Grade 2: urticaria, flush, nausea, vomiting, tachycardia, mild hypotension

Grade 3: Urticaria, flush, nausea, vomiting, diarrhoea, tachycardia, shock symptoms, bronchospasm, possibly Quincke-Ödem

Grade 4: cardiovascular arrest

Septic Shock

Infection with bacteria, bacteremia and endotoxinemia

Symptoms are fever, chills, warm periphery, blood pressure <90 mmHg, tachycardia, dyspnoea, tachypnoea up to respiratory insufficiency.

Neurogenic Shock

In lesions of the cervical spine or BWS with spinal cord injury, on the one hand respiration is impaired (depending on the height of the lesion, loss of the intercostal muscles up to phrenic paresis) and on the other hand functional sympathectomy with bradycardia and hypotension occurs due to loss of the sympathetic nerve fibres.