The hypovolaemic shock
The hypovolemic shock is accompanied by a reduction in the amount of circulating blood. A volume deficiency of up to 20% (about 1 liter) is usually well compensated by the body. While the blood pressure remains largely stable in stage 1 of hypovolemic shock, it drops below 100mm Hg systolically in stage 2, the pulse rate rises to > 100/min and there is a strong feeling of thirst and a lack of urine production as a sign of the volume deficiency.
In stage 3 the blood pressure drops below 60mm Hg, the pulse is barely present and breathing becomes rapid and shallow. As a rule, the symptoms are accompanied by disturbances of consciousness.
- Blood and plasma losses, for example due to organ injuries or
- Pelvic fractures with ruptures of the large vessels,
- Massive vomiting or diarrhea
- Or massive fluid deficiency (dehydration)
The cardiogenic shock
In contrast to this is the cardiogenic shock, which is caused by a pump failure of the heart.This can have various reasons, for example Cardiogenic shock is diagnosed by a systolic blood pressure drop < 80mm Hg, a heart index < 1.8l/min/m2 (heart minute volume related to the body surface) and an end-diastolic pressure in the left heart > 20mm Hg.
- A heart attack,
- Heart muscle inflammations,
- Flap malfunctions or the
- Pulmonary embolism.
The third major group of shock causes is the failure of peripheral circulation regulation due to anaphylactic or septic shock. Anaphylactic shock occurs in the case of massive allergic reactions, for example, triggered by a wasp sting.
Septic shock, on the other hand, is caused by a massive inflammation that spreads through the blood and thus leads to blood poisoning. If the inflammation lasts too long, it can spread throughout the body and lead to a generalized inflammatory reaction of the body. Patients usually suffer from an underlying disease, such as organ perforation (piercing of organs), a major injury or infection with highly pathological bacteria.
- Drop in blood pressure,
- Heart rate increase and can be increased up to
- Cause respiratory and circulatory arrest.
- Under temperatures > 38 °C or < 36 °C,
- The heart rate increases > 90 beats per minute,
- The breathing rate increases > 20/min and the
- Laboratory values show inflammation markers, such as elevated CRP and leukocytosis (increased white blood cells in the blood).
The symptomatic treatment of the shock is the same, regardless of the cause. The main focus here is on monitoring blood pressure, pulse, respiration, urine excretion and blood count. In addition, patients are supplied with oxygen via a nasal probe and the airways are kept clear.
The causal therapy differs depending on the cause.
- Hypovolemic shock is mainly treated by sufficient volume administration. This is the only way to save the patient’s life.
Initially, 500-1000 ml of a plasma expander are given intravenously. Plasma expanders are colloidal plasma substitutes with a higher oncotic pressure than the body’s own plasma. This leads to a maximum fluid flow into the vessels and thus has a volume effect of > 100%.
Further volume compensation is done with isotonic saline solutions to compensate for the cellular fluid deficit. If larger blood losses are the cause of the hypovolemic shock, they are compensated by the administration of blood transfusions. Of course, the source of the blood loss must be treated, i.e. the bleeding vessel must be closed or the causal injuries must be treated.
- Cardiogenic shock is treated symptomatically by elevating the upper body and morphing to treat the pain of a reduced oxygen supply to the heart muscle.
Causally, the cardiogenic shock is treated depending on the specific cause. If a heart attack is the reason for the shock, the heart vessels must be reopened and supplied with blood. In case of valve dysfunction, these are treated surgically.
Inflammation of the heart muscle must be treated by administering antibiotics and bed rest. Pulmonary embolism by dissolving the blood clot with medication or surgery.
- The anaphylactic shock must be treated quickly with medication to stop or counteract the body’s own reactions to the allergen. Patients are supplied with sufficient fluid through the vein (2000 – 3000ml in 30min).
Patients are also administered histamine antagonists. These inhibit the body’s own histamine, which is responsible for the allergic reaction. To stabilize the circulation, constrict blood vessels and possibly for resuscitation, the patient is injected with adrenaline.
If the allergic reaction leads to a massive narrowing of the bronchial tubes, a fast-acting bronchodilator is administered by inhalation or intravenously. If the airways become swollen, the patient must be intubated and ventilated early. Regardless of the extent of the anaphylactic reaction, all patients are monitored for at least 24 hours as inpatients.
- Septic shock must be treated primarily by treating the underlying disease.
This means that the entry point/focus of the infection must be found and repaired. In addition, the patients are treated with broad-spectrum antibiotics and a target-oriented cardiovascular therapy is initiated. This includes, if necessary, volume and oxygen administration.
To prevent possible generalized coagulation, a small dose of heparin can be administered prophylactically.As a general rule, patients must be monitored as in-patients over a longer period of time to avoid a possible resurgent infection with signs of sepsis. This is achieved by continuous monitoring of heart rate, blood pressure, temperature and respiration. In addition, the general condition of the patient is an important parameter for monitoring the success of the therapy.
