Shock Treatment

General measures

  • Immediately make an emergency call! (Call number 112)
  • Symptom-oriented positioning of the patient:
    • Dyspnea (shortness of breath): elevate upper body (semi-sitting).
    • Circulatory dysregulation (hypovolemia: reduction in circulating blood volume): flat positioning with legs elevated (Trendelenburg positioning).
    • Clouding of consciousness: stable lateral position (to keep the airways free: fall back of the tongue and possible vomiting to prevent).
  • Placement of venous access (min 18 G) to treat impending hypovolemia (decrease in circulating blood volume): In case of anaphylaxis:
    • Adults: 5-10 min briskly 500-1,000 ml of fluid (more if necessary).
    • Children: 20 ml/kg bw
  • Administration of pure oxygen with high flow rate.
  • Securing the airway (endotracheal intubation/insertion of a tube (hollow probe) through the mouth or nose between the vocal folds of the larynx into the trachea)

Conventional non-surgical therapy methods

  • Percutaneous coronary intervention or percutaneous coronary intervention (abbreviation PCI; synonym: percutaneous transluminal coronary angioplasty, PTCA; percutaneous transluminal coronary angioplasty); indication: infarct-related cardiogenic shock; note: earliest possible revascularization of the occluded/stenosed coronary vessel (“culprit lesion”) – and “usually by means of primary PCI (pPCI).
    • For revascularization of infarct-related shock, intracoronary stenting using drug-eluting stents (DES) should be preferred.”
    • “In the patient with multivessel coronary disease and multiple relevant stenoses (>70%), only the infarct-causing lesion (“culprit lesion”) should be treated during acute revascularization.”

Training

  • Emergency training: anaphylaxis training is one of the most important preventive measures after anaphylaxis.