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Types of
Shock
Hemorrhagic
(resulting from the loss of blood.
Metabolic
(resulting from profound fluid loss in an untreated
illness).
Cardiogenic
(resulting from injury to theheart itself).
Neurogenic
(resulting from the loss of effective nervous control of
blood vessels).
Toxic or septic
(resulting from the effect of toxic substances on the
body).
Respiratory
(resulting from impaired breathing).
Psychogenic
(fainting).
Anaphylactic (a
form of toxic shock that follows an overwhelming allergic
reaction).
SIGNS
AND SYMPTOMS OF SHOCK
The most common early
manifestation of shock include restlessness, mental
confusion, and disorientation. These are accompanied by
evidence of the body's attempt to compensate, resulting in
such associated signs and symptoms as skin paleness, rapid
pulse, coldness of extremities, thirst, and dryness of the
mouth. In early shock, the pulse rate may be normal or
slowed, or it may be quite rapid. Late symptoms of shock
include low or unobtainable blood pressure; rapid, "thready,"
or unobtainable pulse; a bluish or purplish discoloration
of the skin; dilated pupils; faintness or unconsciousness;
and irregular, gasping respirations. It is important to
remember that low blood pressure (hypotension) is a late
and usually serious sign of shock. Remember -- a restless
hypoxic patient who is in need of oxygen and lower
extremity elevation can be in shock and have near normal
blood pressure. The signs and symptoms of shock should not
be studied merely as a means of identify- ing shock;
rather, they are of tremendous help in determining what
will be required in treatment of shock. What we call
"shock" is simply the total of the body's
response to a particular type of injury. For instance,
consider the teenage boy who faints in the excitement of
seeing a celebrity in person. He obviously represents a
far different medical problem than the victim of an
automobile accident who is found unconscious in a pool of
blood; yet, both are in shock. Both can be described by
the following signs of shock:
1.
Condition of the skin -- pale, covered
with sweat, cold, and clammy.
2.
Condition of the blood pressure -- gradual drop or
unobtainable.
3.
Condition of the brain's activity --
confusion, restlessness, and possibly unconscious.
4.
Condition of the pulse -- weak,
difficult to find.
There is a
difference -- if you know what to look for. The pulse rate
of the boy is essentially normal, perhaps slower than
normal, while the pulse rate of the accident victim is so
rapid that it is difficult to count. The boy is in early
neurogenic shock; the accident victim is in late hemorrhagic
shock. In summary, the most common signs and symptoms of
shock include:
1.
Restlessness, anxiety, weakness, anxious or dull expression,
and disorientation (often precede other signs and symptoms).
2.
Weak and rapid (thready) pulse.
3.
Cold, clammy, moist skin.
4.
Profuse sweating.
5.
Initially, a dull, chalklike
appearance to the patient's skin, regardless of color;
later, a bluish (cyanotic) color to the skin.
6.
Shallow, irregular breathing; may be
labored, rapid, or gasping.
7.
Closed or partially closed eyelids;
dull, lusterless eyes; dilated pupils.
8.
Extreme thirst.
9.
Nausea and possible vomiting.
10.
Gradual and steady drop in blood
pressure (to 90/60, or lower); eventually, blood presure
that is unobtainable.
11.
Possible fainting in cases of rapidly
developing transient shock.
12.
Shaking and trembling of the arms and
legs, as if chilled.
13.
Feeling of impending doom.
Causes
of Anaphylactic Shock
1.
Insect stings -- including bee, wasp, hornet, yellow
jacket, and other stinging insects. Reaction is usually
severe and rapid.
2.
Injected serums or drugs. The tetanus antitoxin sometimes
causes anaphylactic shock, as does the drug penicillin
(whether ingested or injected, although the reaction is
more rapid from injection).
3.
Foods. Common foods that precipitate anaphylactic shock
include shellfish, fish, berries (especially
strawberries), and milk. The reaction is usually gradual
but can become very severe.
4.
Drugs. Depending on the sensitivity of the person, a
simple drug like aspirin can cause fatal anaphylactic
shock.
5.
Inhaled substances. If a person is allergic to them,
inhaled substances such as ragweed, pollens, animal hair,
and dust can produce anaphylactic shock.
Signs
& Symptoms of Anaphylactic Shock
1. Signs
and symptoms involving the skin: · Itching and burning of
the skin with flushing, especially around the face and
chest. · Blueness (cyanosis) around the lips. · Raised,
hivelike patches with severe itching . · Swelling of the
face and tongue. · Paleness. · Swelling of the blood
vessels just underneath the skin.
2. Signs
and symptoms involving the heart and circulation:
- Weak, rapid pulse.
- Low blood pressure.
- Dizziness.
- Restlessness.
- Diminished stroke volume and cardiac output.
3. Signs
and symptoms involving the respiratory tract:
- Spasm of the bronchioles.
- A painful, squeezing sensation in the chest.
- Difficulty in breathing.
- Coughing, bronchial obstruction.
- Swelling of the larynx.
- Swelling of the epiglottis.
- Respiratory wheezes.
4. Signs
and symptoms involving the gastrointestinal tract:
- Nausea.
- Vomiting.
- Abdominal cramps.
- Diarrhea
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