Question

Ms. L, a 19-year-old woman with no previous medical history, was involved in a serious automobile accident in which her best friend died. Examination by EMT personnel first on the scene revealed she had only minor scrapes and bruises and no sign of head trauma. While en route by ambulance to the hospital, Ms. L complained of thirst and appeared restless. Further examination indicated a rapid pulse and respirations, with her blood pressure now at 100/60 mm Hg. She appeared less responsive to the paramedics. She was slipping into circulatory shock as they checked her again for internal injuries

Compare the types of shock, giving a specific cause, classification, and any significant changes in onset or manifestations.

Answer 1

SHOCK- shock is a syndrome characterised by decreased tissue perfusion and impaired cellular metabolism. This result in an imbalance between the supply of demand for oxygen and nutrients.

TYPES OF SHOCK- 1. Cardiogenic shock

2. Hypovolemic shock.

3. Distributive shock.

4. Obstructive shock.

comparison of types of shock in terms of cause , classification , and menifestation--

1. CARDIOGENIC SHOCK-

Types and causes - systolic dysfunction: inability of the heart to pump blood forward Diastolic dysfunction: inability of the heart to fill. Dysrhythmias Structural factors

Examples- Myocardial infarction, cardiomyopathy, blunt cardiac injury, severe systemic or pulmonary hypertension , myocardial depression from metabolic problems. Cardiac tamponade, ventricular hypertrophy, cardiopathy Bradydysrhythmias, tachydysrhythmias Valvular stenosis or regurgitation, ventricular septal rupture , tension pneumothorax.

Menifestation-

• Cardiac output will be decreased.
• Systolic vascular resistance will be increase.
• Pulmonary capilary wedge pressure will be increase

Mixed venous oxygen saturation will decrease.

2. HYPOVOLEMIC SHOCK-

Types and causes- ​​​​​​Absolute Hypovolemia- * Exaternal loss of whole blood. * loss of other body fluids 2.Relative hypovolemia- Pooling of blood or fluids Fluid shifts Internal bleeding Massive vasodilation

Examples- * Hemorrhage from trauma, surgery , GI bleeding . * Vomiting , Diarrhea, excessive diuresis , diabetis insipidus , diabetis mellitus. Bowel obstruction Burn injuries, ascites Fracture of long bone , ruptured spleen , hemothorax , severe pancreatitis Sepsis

Menifestation-  

• Cardiac output will be decrese
• Systolic vascular resistance will be increase
• PCWR will decrease.

MVO₂ will decrese.

DISTRIBUTIVE SHOCK-

Types and causes- Neurogenic shock- Hemodynamic consequence of spinal cord injury and/ or disease at or above T5 Spinal anesthesia Vasomotor center depression

Examples- Severe pain, drugs , hypoglycemia , injury

Menifestation- ​​​​​​​

	CO	SVR	PEWP	MVO2
Neurogenic shock	Decrease	decrease	no change	decrease
Anaphylactic shock	Increase	decrease	decrease	increase
Septic shock	First increase than decrease	decrease	no change or decrease	increase or decrease

4. OBSTRUCTIVE SHOCK-

types and causes physical obstruction impeding the filling or outflow of blood resulting in resulting in reduced cardiac output

Examples- Cardiac tamponade , tension pneumothorax , superior vena cava syndrome , abdominal compartment syndrome , pulmonary embolism.

Menifestation-

• Cardiac output (CO) will decrease
• Systolic vascular resistance (SVR) will increase
• Pulmonary cappilary wedge pressure(PEWP) will increase
• Mixed venous oxygen saturation (MVO₂) will decrease

Answer 2

There are mainly 5 types of Shock

Hypovolemic shock

It occurs due to severe blood loss or any other fluid loss, Severe fluid loss causes severe hypotension which causes tissue hypoxia and death.

Cardiogenic shock

It is due to heart failure, which means due to the inability of the heart to pump enough blood. It is characterized by severe hypotension and pulmonary edema.

Septic shock

It is due to septicemia, a severe infection of the blood. It is characterized by high-grade fever then hypothermia and multiorgan failure.

Anaphylactic shock

It is due to an extreme reaction to an antigen. It is characterized by skin rash, flushed skin, vomiting, etc.

Neurogenic shock

It is due to damage to the nervous system. It is characterized by Hypotension and Bradycardia.

- In this case, the patient is on Hypovolemic shock due to severe blood loss by an internal injury.