Let's make sure you've got the fundamentals of the types of shock - distributive, hypovolemic, obstructive, and cardiogenic.
Shock is defined as organ and tissue hypoperfusion secondary to inadequate oxygen delivery/supply. Patients can rapidly deteriorate if etiology of shock is not identified and treated. Cellular dysfunction and multiorgan failure manifests into a high acuity situation. Several causes contribute to different forms of shock; distributive, hypovolemic, cardiogenic, and obstructive shock.
Shock identification is crucial to determine treatments for the underlying cause. Mistreating shock may contribute to worsening clinical status. Let's make sure you've got the fundamentals of the types of shock - distributive, hypovolemic, obstructive, and cardiogenic.
What is Shock?
Shock results from the insufficient oxygen supply to meet the body's demand, resulting in hypoperfusion of the organs and tissues.
Peripheral vascular tone, blood volume, and heart function are the sources of shock etiology.
Distributive Shock
Peripheral vasodilation from inflammatory mediators or dysregulation within the autonomic sensory pathway.
Reduced systemic vascular resistance leads to blood pooling in expanded vessels.
Decreased venous return subsequently compromises cardiac output
Examples of distributive shock
Septic shock
Anaphylactic shock
Neurogenic shock - #PHARMFAX: Neurogenic Shock Reel
Treatment
Vasoactive agents
Hypovolemic Shock
Decreased intravascular tone impairs oxygen delivery to vital organs and tissues.
Hypovolemic shock can be nonhemorrhagic or hemorrhagic, both from excess body fluid or blood loss.
Reduced intravascular tone results in reduced preload.
Hemorrhagic shock requires resuscitation with blood products.
Treatments
Crystalloid fluid
Blood products
Obstructive Shock
Obstruction of the extracardiac system that hinders blood flow to the heart.
Address the underlying obstruction to maintain blood circulation
Examples
Pulmonary embolism - #PHARMFAX: Massive Pulmonary Embolism Reel
Cardiac tamponade
Tension pneumothorax
Treatments
Decompression
Thrombolytics
Cardiogenic Shock
Various cardiac insults that prevent adequate cardiac filling.
Decreased cardiac output cannot efficiently maintain organ perfusion and meet bodily demands.
Examples
Myocardial infarction - #PHARMFAX: ST-Elevation Myocardial Infarction Reel
Ventricular dysarrythmias
Treatments
Revascularization
Differentiating the Types of Shock
It is crucial to identify the correct form of shock and treat as appropriate.
Misclassifying shock is detrimental (crystalloid resuscitation in hemorrhagic shock)
Assess the patient's clinical presentation, medical history, and diagnostic tests to accurately identify the type of shock and tailor interventions accordingly.
On the Way to Death Without Treatment
In the intricate landscape of medical emergencies, shock emerges as a critical condition demanding prompt recognition and intervention. Distributive, hypovolemic, cardiogenic, and obstructive shock have distinct challenges and mechanisms, necessitating targeted therapeutic approaches. A foundational understanding of these types of shock equips medical practitioners and individuals alike with the knowledge needed to identify warning signs, seek timely medical assistance, and contribute to improved patient outcomes.
Mark Nguyen, PharmD, BCEMP
References
Standl et al. The Nomenclature, Definition and Distinction of Types of Shock. Dtsch Arztebl Int. 2018 Nov; 115(45): 757–768.
Blumlein D, Griffths I. Shock: aetiology, pathophysiology and management. Br J Nurs. 2022 Apr 21;31(8):422-428. doi: 10.12968/bjon.2022.31.8.422.
Kislitsina et al. Shock - Classification and Pathophysiological Principles of Therapeutics. Curr Cardiol Rev. 2019;15(2):102-113. doi: 10.2174/1573403X15666181212125024.
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