Circulatory Shock –A Critical Condition!!!

THE tissues and organs in the human body require blood circulation at the rate that is very adequate to function. The blood is a transport medium that carries both nutrients and oxygen needed by the organs to stay healthy and carry out their individual functions properly, in a situation where there is inadequate supply the result is problematic. A life threatening medical condition of low blood introduction into the tissues resulting in cellular injury and inadequate tissue function is known as Circulatory shock and can also be referred to as shock. Circulatory shock is one of the most common causes of death for critically ill patients. The risk factors of shocks may be hypoxemia (an abnormal deficiency in the concentration of oxygen in the blood), cardiac or respiratory arrest. The key danger of shock is its progression which is in a positive feedback mechanism. The onset of circulatory shock may be characterised by rapid heart rate, poor end oxygen perfusion etc. It is very important to note that blood pressure alone may not be a reliable sign of shock; for example, a patient can be in shock but has a stable blood pressure. Circulatory shock should not be confused with emotional state of shock.
S
igns and symptoms
S
igns and symptoms of circulatory shock may present differently in patients. Some patients may only suffer from minimal symptoms; for example, a patient suffering from confusion and weakness, while in other patient the whole load of symptoms may be present.
T
he general signs and symptoms are:
•Low blood pressure
•Decreased urine output
•Confusion
•Fast heart rate
•Weak pulse
Subtypes of circulatory shock
•Hypovolemic: Characterised by a direct loss of circulatory blood volume leading to rapid weak and thread pulse.
•Distributive: These includes infectious, anaphylactic and neurogenic causes
•Cardiogenic: Distended jugular veins due to jugular venous pressure.
• Obstructive: Includes pulmonary embolism and aortic stenosis
Causes
Shock is a common end point of many critical medical conditions:
•Loss of fluid from circulatory , vomiting and diarrhea
•Congestive heart failure (CHF)
•Contusiocordis
•Valvular heart diseases
•Cardiac tamponade
•Aortic stenosis
Treatment/management
Management of circulatory shock may include the following:
•Securing the air way via intubation.
•Decreasing the work of breathing and guarding against respiratory arrest.
•Oxygen, Intravenous fluids supplementation
•Blood transfusion if needed in severe cases.
Note: It is very important to keep the patient warm at all times, also pain and anxiety management. The use of medication (vasopressors) can help to improve the blood pressure.
Medical support:
•Extracorporeal membrane oxygenation (ECMO)
•Artificial heart (TAH)
•Ventricular assist device (VAD)
•Intra-aortic balloon pump(IABP)