SHOCK

Shock is the condition resulting from a depressed state of many vital function of the body. The vital functions are depressed when there is a loss of blood volume or reduced rate of blood flow. Hypotension leads to an insufficient supply of oxygen to the vital organs. There are different types of shocks:-
Ø Cardiogenic
Ø Hypovolaemic
Ø Septic
Ø Anaphylactic
Ø Neurogenic
Cardiogenic shock:
Poor cardiac function leads to drop in blood pressure.
Hypovolemic shock:
Loss of blood/ plasma volume and body fluid volume. eg. bleeding, diarrhea, burn.
Septic shock:
Infection leads to large drop in blood pressure.
Anaphylatic shock:
It is life threatening allergic reaction.
Neurogenic shock:
Central nervous sysyem disease leads to fall in blood pressure.
Important symptoms:
-         Dizziness
-         Sweating
-         Nausea
-         Vomiting
-         Loss of consciousness.
-         Weakness, oliguria or anemia.
Important signs:
-         Fast and feeble pulse.
-         Low BP.
-         Cold and clammy skin.
-         Pallor
-         Sunken eyes with vacant expression and dilated pupils.
-         Pre- existing infection or immune suppression.
Differential Diagnosis:
-         CVA
-         DKA
-         Poisoning
-         Liver diseases
-         Renal failure
-         Meningitis
Screening the risk factors:
-         Taking steroid
-         Alcohol
-         Drugs
Investigation:
-         When cause unknown-RBS, BUN
-         When septic shock- WBC, Blood culture.
-         When trauma or hypovolaemic shock- PCV, Blood group, crossmatch, Na+K, Serum urea, creatinine.
Management of Shock:
1.     Shout for help.
2.     General management:
-         Keep airway open.
-         If the women is unconscious, turn her on left side.
-         Monitor vital sign ( BP, Pulse, respiration, temperature and state of consciousness)
-         Elevate the foot end.
-         Keep the patient warm with blanket.
-         Catheterization
-         If possible check blood group and RH factor.
3.     Specific management:
-         Start iv infusion in both arms with large bore cannula or needle (16 G or 18 G cannula)
-         Rapidly infuse iv fluid (NS or RL) initiating at the rate of 1 litter in 15-20 minute.
-         Give at least 2 litter in the first hour.
-         Monitor vital signs every 15 minutes till the patient is stable.
-         Catheterize the patient and maintain strict intake output ( Urine output should be maintained at least 30ml/hrs).
-         If needed, start resuscitation.
-         Administer oxygen at 6-8 litter per minute by mask or nasal cannula.


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