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.

Discuss the signs and symptoms of shock, including the rationale for each, as seen in the early stage, and as compensation mechanisms respond. (See Shock—Etiology

Answer 1

Answer 2

ANSWER :

Shock is a state of insufficient blood flow to the tissues as a result of problem with circulatory system.

Based on the under line causes, four main types of shock are present.

• HYPOVOLEMIC SHOCK ( Eg, bleeding, diarrhoea, vomiting, pancreatitis)

in this case the patient is suffering from hypovolumic shock , not because of obvious external bleeding , but due to blunt trauma to organs especialy abodminal organs like liver , spleen , these are highly vascular organs and blunt injury will leads to damages of these tissue and blood vessels , at initial stages of injury , there may be no symptoms except some bruise over abdomen at the position of liver and spllen. in these suspected cases we should do one emergency usg whole abdomen(focused assessment with sonography for trauma - FAST) and we can find out any free fluid or blood in the abdominal cavity,

Signs and symptoms are ;

a. rapid , weak , thready pulse and tachycardia due to decreased blood flow to the tissues.

b.   cool skin due to compensatory peripheral vasoconstriction to provide adequate blood supply to the vital organs.

c. rapid and shallow breathing due to compensatory sympathetic nervous system stimulation and acidosis.

d. hypothermia due to decreased perfusion and evaporation of sweat.

e. thirst and dry mouth due to fluid depletion.

f. low urine output due to blood flow diverted to vital organs like brain , heart..

g. low bp due to ongoing blood loss and patient develop weakness , giddiness, blurring of vision

Shock state leads to decreased central venous pressure, decreased cardiac output and decreased arterial pressure, which leads to increased sympathetic activity and decreased parasympathetic activity, results in increased heart rate and contractility which in turn increases cardiac out put. Increased vascular resistance will increases arterial pressure. Increased venous tone will increases central venous pressure and through these process body tries to maintain the cardiac out put.

If shock is prolonged , these initial compensatory mechanisms fail and tissues uses anerobic metabolism for energy and produce lactic acidosis , cellular and organ dysfunction , metabolic abnormality.irrevesible cell damages and cell death.

Diagnosis is mainly clinical symptom, vitals, hemoglobin , hematocrite. chest x ray to see any hemothorax. usg abdomen and thorax

Managment is mainly aggresive fluid therapy to maintain vascular volume, emergency blood transfusion, vasporessors like adrenaline , noradrenaline. monitor vitalas and urine output ,hemoglobin  and adjust fluid and blood requirments accordingly.

• CARDIOGENIC SHOCK (heart attacks, cardiac contusion)
• OBSTRUCTIVE SHOCK( cardiac tamponade , tension pneumothorax)
• DISTRIBUTIVE SHOCK (sepsis, anaphylaxis , injury to spinal cord)

Answer 3