Definition

Any problem that leads to a decrease in the efficiency of the cardiovascular system in a patient may result in shock. Shock has many causes but ultimately it is a problem of tissue perfusion affecting the individual body cells. If allowed to progress, the tissue, organs, organ systems, and ultimately the patient will die. Shock can be classified into several types; specific identification of types of shock allows for more definitive treatment.

Signs and Symptoms

• Changes in mental status:
  • Apathy
  • Confusion
  • Restlessness
  • Agitation (due to cerebral hypoperfusion)
• Changes in circulatory status:
  • Pulse >120 bpm or <40 bpm (may be a late and dangerous sign)
  • Blood pressure < 90mmHg systolic and/or a falling trend
  • Mean Arterial Pressure < 60mmHg
  • Signs of circulatory failure include jugular vein distension, wet lung sounds
• Changes in presentation:
  • Skin may be pale, sweaty, cool, mottled
  • If flushed, may indicate neurogenic shock
  • Capillary refill >2 seconds indicative of poor circulation
• Increased respiratory rate
• Signs of trauma, particularly evidence of blunt injury to major body region.

Types of Shock

Documentation

History: 

• Sudden or gradual onset?
  
• Precipitating cause or event
• Allergies, medications, bloody vomitus or stools, significant medical diseases, trauma; especially truncal, long bone and pelvis.
• A high index of suspicion should be associated with high impact mechanisms and patterns of injury involving underlying major organs.