Chapter 11 Shock
Shock is a clinical condition, commonly encountered in practice, with multiple causes which share the final common pathway of inadequate tissue perfusion. The consequence of inadequate perfusion is that insufficient metabolic substrates (primarily oxygen) are provided to sustain cellular homeostasis. The challenge for the clinician is to manage the shock, and to simultaneously seek and treat the cause.
CAUSES AND EFFECTS
Causes of shock are loosely grouped as follows:
A more complete list of causes is given in Table 11.1. A patient in shock will manifest signs of:
| Type of shock | Causes | Signs |
|---|---|---|
| Hypovolaemic | ||
| Cardiogenic | ||
| Distributive | ||
| Obstructive |
AMI, acute myocardial infarction; DVT, deep vein thrombosis; JVP, jugular venous pressure
OVERVIEW OF MANAGEMENT
Shocked patients should be managed in a fully monitored area. The assessment and treatment of the shocked patient should occur in parallel. Initial treatment focuses on resuscitation, monitoring (to assess response to treatment) and seeking a specific cause (history, examination and investigations). Once the cause of shock has been determined, specific therapy should be considered. What follows is a description of initial management, then a description of specific therapies once the cause is known.
