This document defines and describes the different types of shock, including anaphylactic, cardiogenic, hypovolaemic, neurogenic, and septic shock. It provides details on the causes, signs, and emergency management for anaphylactic shock. Management of cardiogenic shock includes oxygen, pain relief, investigations, and close monitoring. Hypovolaemic shock requires rapid fluid resuscitation and treating the underlying cause of blood or fluid loss. Neurogenic and septic shock involve disruption of autonomic pathways and endotoxin-induced vasodilation respectively, and both require ABC support and fluids or antibiotics.

1. SHOCK
KEEPING IT SIMPLE

2. WHAT IS SHOCK?
“A state of hypo-perfusion of organs due to circulatory failure”

3. TYPES OF SHOCK
• Anaphylactic shock
• Cardiogenic shock
• Hypovolaemic shock
• Neurogenic shock
• Septic shock

4. ANAPHYLACTIC
SHOCK
• Type 1 IgE mediated reaction due to allergen
• Mast cell degranulation
• Histamine and prostaglandin release
• Dilated & permeable blood vessels
• Hypotension
• Release of leukotrienes
• Smooth muscle contraction

5. MEDICAL EMERGENCY
• ABC
• Adrenaline 0.5mg IM!!
• Repeat every 5 minutes if needed
• Oxygen
• IV access
• Hydrocortisone 200mg IV & Chlorphenamine 10mg IV
• Fluids
NB
• Measure tryptase
• Monitor for 6-8 hours

6. CARDIOGENIC SHOCK
• Hypo-perfusion of tissues due to cardiac dysfunction
• HIGH mortality
• Can occur acute or progressively
• Causes include; MI, PE, arrhythmias, heart failure

7. MANAGEMENT OF
CARDIOGENIC?
• ABC
• Oxygen
• IV diamorphine (2.5-5mg)
• Investigations
• ECG, U&Es, Cardiac enzymes, ABG, CxR, Echo
• Close monitoring of
• CVP, BP, ABG, urine output *catheterize, ECG **hourly

8. HYPOVOLAEMIC
SHOCK
• Haemorrhage OR Fluid loss
• Severe
• Blood loss of >2L
• Tachycardia >140bpm
• Low BP
• Tachypnea/Respiratory collapse
• Cold, mottled skin
• Obtund
• Anuria

9. MANAGEMENT
• BP unrecordable? Call crash team!
• ABC (high flow O2)
• IV access x 2
• FLUIDS FAST
• (Blood if blood loss)
• Treat underlying cause
• Ring for help

10. NEUROGENIC SHOCK
• Disruption of autonomic pathways within spinal cord
• E.g. post-spinal surgery/blunt trauma
• Loss of stimuli for blood vessels
Dilate & reduce vascular resistance
Hypotension
• Management
• ABC
• Oxygen
• Fluids
• Vasopressors/inotropes if required.

11. SEPTIC SHOCK
• Endotoxin induced vasodilatation
• Fever
• ABC, oxygen
• IV antibiotics within 1hour (blood cultures before if possible)
• Refer to ITU

13. REFERENCES
Oxford Handbook of Clinical Medicine
Google Images
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