Pathophysiology of Shock
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Pathophysiology of Shock
Shock refers to an acute diffuse reduction in the total peripheral vascular resistance and cardiac output. It is classified as either a circulatory shock or a cardiogenic shock. The term “shock” is typically used to describe the clinical condition but it can also refer to a reaction from the body after suffering damage to blood vessels or the heart muscle, as in how an individual would react if shocked by “shocking” news about their long-held assumptions about how people were supposed to live (Font et al., 2020).
Circulatory shock is a state of low blood pressure, which may be caused by numerous diseases. When the heart fails to pump enough blood through the body, the organs and tissues of the body are deprived of oxygen and nutrients. The resulting ischemia causes damage to these tissues, urine output falls and metabolic acidosis develops. Circulatory shock may develop abruptly but more commonly develops as a slow deterioration of organ perfusion over time. Circulatory shock can be viewed as a medical emergency since it leads to impaired function of vital organs such as the liver, kidneys, or brain (Font et al., 2020). As result, circulatory shock is associated with high mortality rates if left untreated.
A person may be at risk for developing shock when they have significant external trauma or internal bleeding that leads them into hypovolemic shock. Hypovolemic shock is typically the result of a significant loss of fluids, electrolytes, proteins, or blood. It can also be considered to be a state of circulatory failure that occurs when there is a sudden loss or drop in blood pressure resulting from inadequate fluid volume in the circulatory system. In this type of shock, patients may show signs and symptoms associated with hypovolemic shock. The main cause of hypovolemic shock is blood loss; however, this can occur naturally when delivering a baby or through injuries such as gunshot wounds and major cuts. In hypovolemic shock, the heart begins to lose its ability to contract and pump blood (Font et al., 2020).
Normal Anatomy of Major Body System Affected.
The major body system affected by shock is the cardiovascular system. The normal anatomy of the cardiovascular system is as follows:
The heart is located in the middle of the upper chest or thorax. It consists of three chambers: a left and a right atrium, and left and right ventricle. Each chamber has one mitral valve to regulate blood flow from one side of the heart to another. There are several coronary arteries that each go to supply branches for the myocardium (heart muscle) in different parts of your body, including arms, legs, and other muscles in addition to your heart. There is one pulmonary artery that goes from your lungs up through your neck into your heart. Shock usually restricts oxygen from reaching the brain which can result in dizziness, fainting, or seizures. The article also discusses other possible effects and diagnoses related to the various body systems affected by shock.
Normal physiology of the major body system affected
The physiology of the major body system affected by shock involves a reduced blood flow to the brain due to injury, which causes changes in mental state and potentially death. At this point, we cannot say for sure what major body system symptoms are caused by shock, but it is known that this major body system can be affected depending on external circumstances such as the severity of the injury or emotional trauma. The major body affected by shock can be affected by other things such as hypothermia, and some of the major physical symptoms that may occur depend on this. There is a danger of death from hypoxia if the person is unable to breathe. Major body system affects The cerebral, renal, respiratory, and cardiovascular systems are all affected by shock. Respiratory failure caused by shock can be mistaken for anaphylactic shock, as these are some of the symptoms that can overlap very closely. Depending on the severity of injury or trauma relation to heart rate, blood pressure and oxygen usage will vary in these systems.
The brain is the most affected system in shock. The brain is made up of neurons, and these are responsible for the thoughts, emotions, and memories that occur within a human being. An extremely sudden change in blood flow to the brain leads to neurogenic shock or CNS shock. A decrease in blood flow can lead to loss of consciousness and this can be mistaken for death by suffocation, which is a specific risk. Blood poisoning occurs because of an infection of the bloodstream, often caused by injury or trauma. Blood poisoning, also known as sepsis, causes loss of function due to inflammation and infection within the body’s vital organs. Blood poisoning can lead to much worse consequences than permanent death from CNS shock.
Mechanism of Pathophysiology
The mechanism of the pathophysiology of Shock involves three separate phases: alveolar flooding, hemodynamic collapse, and ischaemic brain. The processes in these three steps are interdependent; they may also be separated into physiological processes of the lung, systemic blood pressure, and cerebral blood flow. Hemodynamic collapse occurs when the heart is unable to maintain adequate cardiac output to maintain normal systemic blood pressure and thus perfusion pressure of the tissues. This results in systemic hypotension, which may lead to irreversible hypoxic injury, acidosis, and death if not successfully treated (Dugar et al., 2020). In patients who have suffered a major hemorrhage and their vital signs show reduced or undetectable blood pressures, giving volume (crystalloid + colloid) is not sufficient. Therefore, when the pressure in the lungs falls suddenly (as with suffocation), this leads to alveolar flooding which leads to hemodynamic collapse which leads to ischaemic brain damage (Dugar et al., 2020).
Prevention of Shock
There are various prevention mechanisms for shock. Avoiding various lifestyles like smoking, unsafe sexual intercourse and unhealthy eating habits can help. But, there are also techniques to use in combat if the body is already in shock. If the person has a poor immune system and has cuts or open wounds, it is vitally important that those wounds be covered with clean dressings or bandages.
In cases of poor circulation, laying the person on his back, raising his legs 12 inches from the ground [or] putting both legs up on a bed may restore blood flow to healthy tissue by elevating blood pressure. Consideration should be given to the location of the wound since most wounds involve blood loss, and higher elevations of the legs may make the hemorrhaging worse.
If blood is leaking from fractures of a limb or spine, elevating it below heart level can help to fill that gap and prevent shock. If shock is imminent, placing blood pressure cuffs on both sides of a leg will bring blood back into circulation (Shen, 2021). Shock may also occur if there is a lack of tissue oxygenation due to some kind of interruption in circulation. Tissue damage occurs if circulation is stopped for an extended period without restoring oxygen to tissues.
Treatment
Treatment of shock involves restoring blood flow and oxygenation to the tissues, which may lead to recovery.
The treatment of shock is based on four parameters:
• Blood pressure (BP)
• Temperature
• Respiration Rate (RR)
• Oxygen levels in the blood (SpO2)
Restoring BP and RR is important for treating all forms of shock. Restoring temperature, respiration rates, and oxygen saturations are necessary to treat severe shock (Shen, 2021). All other parameters help treat moderate to severe shock. The ability of the body to generate heat is called core body temperature and depends on several factors like muscle activity, metabolism, and exercise.
Besides core temperature, the body also maintains blood flow, oxygenation, and acid/base balance (among others) through other vital functions at other body parts. Among some of the more important blood parameters, we have blood pressure (BP), which is measured in millimeters of mercury (mmHg or Hg). BP must be maintained, as with a drop in it comes an increase in the risk of shock. If a person’s BP drops too low or falls into a lower range of normal values he may suffer from circulatory collapse, which can lead to death.
References
Dugar, S., Choudhary, C., & Duggal, A. (2020). Sepsis and septic shock: Guideline-based management. Cleveland clinic journal of medicine, 87(1), 53-64.
Font, M. D., Thyagarajan, B., & Khanna, A. K. (2020). Sepsis and Septic Shock–Basics of diagnosis, pathophysiology and clinical decision making. Medical Clinics, 104(4), 573-585.
Shen, Z. A. (2021). The prevention and treatment of shock after severe burns. Zhonghua shao shang za zhi= Zhonghua shaoshang zazhi= Chinese journal of burns, 37, 1-4.
