Hypovolemic shock
Definition
Hypovolemic shock is an emergency condition in which severe blood or other fluid loss makes the heart
unable to pump enough blood to the body. This type of shock can cause many organs to stop working.
Pathophysiology
Hypovolemic shock results from depletion of intravascular volume, whether by extracellular fluid loss or
blood loss. The pre-shock stage is characterized by compensatory mechanisms with increased
sympathetic tone resulting in increased heart rate, increased cardiac contractility, and peripheral
vasoconstriction
Causes
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Losing about one fifth or more of the normal amount of blood in your body causes hypovolemic
shock.
Blood loss can be due to:
Bleeding from cuts
Bleeding from other injuries
Internal bleeding, such as in the gastrointestinal tract
The amount of circulating blood in your body also may drop when you lose too much body fluid
from other causes. This can be due to:
Burns
Diarrhea
Excessive perspiration
Vomiting
Complications
Complications may include:
Kidney damage (may require temporary or permanent use of a kidney dialysis machine)
Brain damage
Gangrene of arms or legs, sometimes leading to amputation
Heart attack
Other organ damage
Death
Treatment
Get medical help right away. In the meantime, follow these steps:
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Keep the person comfortable and warm (to avoid hypothermia).
Have the person lie flat with the feet lifted about 12 inches (30 centimeters) to increase
circulation. However, if the person has a head, neck, back, or leg injury, do not change the
person's position unless they are in immediate danger.
Do not give fluids by mouth.
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If person is having an allergic reaction, treat the allergic reaction, if you know how.
If the person must be carried, try to keep them flat, with the head down and feet lifted. Stabilize
the head and neck before moving a person with a suspected spinal injury.
The goal of hospital treatment is to replace blood and fluids. An intravenous (IV) line will be put
into the person's arm to allow blood, blood products, or fluids to be given.
Medicines such as epinephrine or norepinephrine may be needed to increase blood pressure and
the amount of blood pumped out of the heart (cardiac output).
Role of First Aid Responder
Keep the person still and don't move him or her unless necessary. Begin CPR if the person shows no signs
of life, such as not breathing, coughing or moving. Loosen tight clothing and, if needed, cover the person
with a blanket to prevent chilling. Don't let the person eat or drink anything.
Cardiogenic shock
Definitions
also known as cardiac shock, happens when your heart cannot pump enough blood and oxygen to the
brain and other vital organs. This is a life-threatening emergency.
pathophysiology
The pathophysiology of cardiogenic shock involves a vicious spiral circle: ischemia causes myocardial
dysfunction, which in turn aggravates myocardial ischemia. Myocardial stunning and/or hibernating
myocardium can enhance myocardial dysfunction, thus, worsening the cardiogenic shock.
Most often the cause of cardiogenic shock is a serious heart attack. Other health problems that may lead
to cardiogenic shock include heart failure, which happens when the heart can’t pump enough blood to
meet the body’s needs; chest injuries; and blood clots in the lungs.
Complication
If not treated immediately, cardiogenic shock can lead to death. Another serious complication is damage
to your liver, kidneys or other organs from lack of oxygen, which can be permanent.
Treatment
Emergency and short-term treatments
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Emergency treatments may include delivering enriched oxygen via a tube or mask; breathing
assistance, using a ventilator; and intravenous (IV) fluids and medications to support blood
pressure or heart function.
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Depending on the cause of cardiogenic shock, an array of drugs may be used as part of
treatment. These include:
Clot-busting drugs, such as tissue plasminogen activator (tPA) to dissolve coronary artery
clots
Anticlotting medicines – such as aspirin, clopidogrel or heparin – to prevent new clots
Drugs to increase the heart's pumping ability, such as dobutamine, dopamine and
norepinephrine
Nitroglycerin to relax and widen blood vessels
Drugs that decrease the heart's workload and pain, relieve anxiety or regulate heart rhythm
Longer-term treatments
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Once doctors have determined the cause of a patient's cardiogenic shock, they may
recommend various procedures or devices to address the underlying problem.
For a coronary artery blockage, treatments include:
Coronary bypass surgery – a procedure to create a new route that allows blood to flow around
a narrowed or blocked artery
Percutaneous coronary interventions – minimally invasive procedures that use catheters to
open a blocked artery and restore blood flow
For an abnormal heart rhythm, treatments include:
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Cardioversion – Medication or a brief electric shock resets the heart and restores a normal
heartbeat.
Pacemaker – This small electrical device regulates heartbeats; it's implanted under the skin
and connected by wires to your heart.
Catheter ablation – This minimally invasive procedure disrupts the electrical pathways
causing the heart to beat too fast or irregularly.
Role of First Aid Responder
Keep the person still and don't move him or her unless necessary. Begin CPR if the person shows no signs
of life, such as not breathing, coughing or moving. Loosen tight clothing and, if needed, cover the person
with a blanket to prevent chilling. Don't let the person eat or drink anything.
Septic Shock
Definitions
Septic shock is a life-threatening condition that happens when your blood pressure drops to a dangerously
low level after an infection. Any type of bacteria can cause the infection. Fungi such as candida and
viruses can also be a cause, although this is rare. At first the infection can lead to a reaction called sepsis.
PATHOGENESIS.
Septic shock results when infectious microorganisms in the bloodstream induce a profound inflammatory
response causing hemodynamic decompensation. The pathogenesis involves a complex response of
cellular activation that triggers the release of a multitude of proinflammatory mediators.
Causes
Any infection can lead to sepsis which can then develop into septic shock if it worsens. Not every
infection will lead to sepsis or septic shock. But, if an infection causes enough inflammation, it can
develop into sepsis. Most of the common infections are from bacteria, but both viruses and fungi can also
cause infections and sepsis. Infections can start anywhere but commonly begin in your lungs, bladder or
stomach.
Complications
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The chances of surviving septic shock will depend on:
the cause of infection
the number of organs that have failed
how soon treatment is started
Complications of septic shock can include:
inability of the lungs to take in enough oxygen (respiratory failure)
the heart not being able to pump enough blood around the body (heart failure)
kidney failure or injury
abnormal blood clotting
Treatment
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oxygen therapy
fluids given directly through a vein (intravenously)
medication to increase your blood flow
antibiotics
surgery (in some cases)
Role of First Aid Responder
Lay the person down and elevate the legs and feet slightly, unless you think this may cause pain or further
injury. Keep the person still and don't move him or her unless necessary. Begin CPR if the person shows
no signs of life, such as not breathing, coughing or moving.
Neurogenic shock
Definitions
combination of both primary and secondary injuries that lead to loss of sympathetic tone and thus
unopposed parasympathetic response driven by the vagus nerve. Consequently, patients suffer from
instability in blood pressure, heart rate, and temperature regulation
Pathogenesis
Neurogenic shock is diagnosed based on a person's symptoms and blood pressure levels.
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Neurogenic shock's presentation includes:
warm and pink skin
labored breathing
low blood pressure
dizziness
anxiety
history of trauma to head or upper spine.
if the injury is to the head or neck, hoarseness or difficulty swallowing may occur.
Causes of neurogenic shock include:
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Spinal cord injury (the most common cause).
Autonomic nervous system toxins.
Guillain-Barré syndrome.
Spinal anesthesia.
Transverse myelitis.
Complications
difficulty breathing.
chest pain.
weakness from irregular blood circulation.
bradycardia, or a slower heart rhythm.
faint pulse.
cyanosis, or discolored lips and fingers.
hypothermia, or decreased body temperature.
Treatment
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Your provider will put a collar or neck brace on your neck to keep your injury from getting worse.
First, your provider will treat your low blood pressure with fluids you receive through an IV. Next,
your provider will treat your slow heart rhythm In addition to neurogenic shock treatment, providers
will also give you treatment for injuries from your accident.
Role of First Aid Responder:
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Immobilize the spine to avoid any further damage. Avoid moving
the victim unless there is danger in the immediate environment.
Check the victim’s circulation, airway and breathing. If necessary,
begin rescue breathing and CPR.
Constant check rate of breathing every five minutes even if the
victim is capable of breathing on his or her own.
If there is vomiting or drooling, hold the person’s head, neck and
back in a line and roll the victim to the side as a unit, similar to a log.
Loosen any tight clothing.