Therapy for shock depends on the cause. Basically, stabilization of circulatory conditions must be achieved. Notice:
- In the presence of anaphylactic shock, immediate i.m. Injection of epinephrine is indicated.
- If worsening occurs with volume therapy, think cardiogenic shock; timely catecholamine administration (eg, epinephrine or norepinephrine) should be given.
Treatment recommendations for hypovolemic shock (cause: intravascular volume loss)
- Surgical intervention for hemorrhage
- Volume therapy to restore sufficient circulation (withheld if mass hemorrhage is unstoppable; MAP (mean arterial pressure) ≥ 50 mmHg)
- Up to 30% blood loss can be replaced by crystalloid (and colloid) solutions; contraindication (contraindication): no longer use pure saline solutions because they can cause renal damage and even renal failure
- Depending on the situation, administration of erythrocyte concentrates (EC) with established normovolemia (normal value of the amount of blood in the bloodstream); transfusion indication < 7 g/dl (cave pre-existing conditions); in hypoxia (oxygen deficiency) or non-stopped bleeding also at > 7 g/dl.
- Frozen fresh plasma (FFP) to maintain coagulation in case of massive blood loss, increased bleeding tendency or anticoagulation with medication (3-4 EK:1 FFP).
- Platelet concentrates (TK) in the case of a platelet count (number of platelets) < 50,000/μl.
- Individual blood clotting components in the presence of continuing bleeding.
- In the case of uncontrollable hypotension (low blood pressure), short-term use of catecholamines (epinephrine/norepinephrine).
- Tranexamic acid (antifibrinolytic: drug that inhibits the dissolution of clots) in mass hemorrhage.
- Correction of electrolytes (blood salts) if necessary.
- Prevention of cooling
- Oxygen administration and generous indication of mechanical ventilation.
Therapy recommendations in distributive shock (cause: relative hypovolemia due to pathologic distribution of intravascular volume)
- Therapy consisting of vasoconstriction (vasopressin and vasopressin analog) [guidelines: Canadian Critical Care Society clinical practice guideline] and volume replacement therapy.
- See “anaphylactic shock/anaphylaxis” below.
- S. u. “sepsis”
Therapy recommendations in cardiogenic shock (cause: insufficient cardiac output)
- Therapy consisting of drug therapy, surgery, and interventional therapy.
- See below “Cardiogenic Shock.”
Therapy recommendations in obstructive shock (cause: obstruction of large vessels or the heart)
- Vena cava compression syndrome (synonyms: cava syndrome; hypotensive syndrome); pregnancy complication: circulatory disturbance of the mother due to pressure of the child in utero on the inferior vena cava with obstruction of blood flow to the heart: relieving positioning measures
- Pulmonary artery embolism (pulmonary embolism; blockage of a blood vessel in the lung): thrombolysis (drug dissolution of a thrombus/blood clot)
- Tension pneumothorax (life-threatening form of pneumothorax (“lung collapse”); occurs when air enters the pleural space through an injury without being able to escape): Thoracic drainage (drainage system used to drain fluids and/or air from the chest (thorax)).
- Pericardial tamponade: pericardial drainage (drainage system used to drain fluids from the thoracic sac (pericardium)).
Target hemodynamic therapy:
- Mean arterial pressure (MAD; mean arterial pressure, MAP): 65-75 mmHg; low pressures can be tolerated with adequate diuresis (urinary excretion by the kidneys).
- Clearance (CI; measure of renal clarification or detoxification capacity)I): > 2.5 l/min 1/m 2 or Cardiac Power Output (CPO) > 0.6 W or Cardiac Power Index (CPI) > 0.4 W m-2
- Diuresis: ≥ 50 ml/h
- Lactate: < 2; lactate clearance: > 40%.
