Shock is a state of tissue hypoperfusion relative to the tissues’ metabolic requirements.
Shock has classically been divided into subgroups based on the underlying pathology:
- Cardiogenic
- Septic (NHS Tayside Sepsis 6 Bundle)
- Hypovolaemic (Massive Transfusion Policy), [StaffNet Source]
- Anaphylactic
- Neurogenic
Practically, there is either a problem with one or more of the following:
- the pump (cardiogenic) blood volume (e.g. hypovolaemia / haemorrhage),
- blood vessels are too dilated eg sepsis, anaphylaxis, neurogenic).
Regardless of the type of shock mortality is high and should be regarded as a medical emergency. You need to summon senior help immediately, including the possibility of putting out a cardiac arrest call on 2222.
PRESENTATION
There are no specific parameters for a diagnosis of shock. Presentation depends or the aetiology. Clinically the patient is likely to have some evidence of organ dysfunction:
Tachypnoea
Tachycardia
Hypotension (NB. this is a late sign in hypovolaemia)
Cool peripherally (but not always – early stages of anaphylaxis, septic and neurogenic shock the patient may be tachycardic and hypotensive with warm peripheries due to vasodilatation).
Oliguria
Altered conscious level (may only be irritable or non-compliant due to cerebral hypoperfusion).
