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By ULY CLINIC

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SHOCK

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Shock is a state of acute circulatory failure leading to decreased organ perfusion, with inadequate delivery of oxygenated blood to tissues and resultant end-organ dysfunction and it is an emergency condition. Adherence to evidence-based care of the specific causes of shock can enhance a patient’s chances of surviving. 

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Diagnostic Criteria (Presentation of Shock)

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  • Low blood pressure (systolic BP below 80 mmHg) is the key sign of shock

  • Weak and rapid pulse

  • Rapid and shallow breathing

  • Restlessness and altered mental state

  • Weakness

  • Low urine output 

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Types of shock & Additional Symptoms

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Investigations

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The following investigations can be performed depending on the type of shock

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  • Basic serum chemistry (including renal function)

  • Liver function tests

  • Blood culture

  • Ultrasound

  • Echocardiography

  • Lumbar puncture if a patient is suspected with meningitis 

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Non-Pharmacological Treatment

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Prompt diagnosis of underlying cause is essential to ensure optimal treatment.

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  • Maintain open airway

  • Administer oxygen with face mask and if needed after intubation with assisted ventilation

  • Check for and manage hypoglycemia

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Pharmacological Treatment

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Treatment depends on the type of shock. Intravenous fluid therapy is important in the treatment of all types of shock except for cardiogenic shock. 

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Adults:

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0.9% Sodium chloride given as the 1L bolus infusion. Repeat bolus until blood pressure is improved. Transfuse blood and plasma expanders (-) in hemorrhagic shock

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 Children:

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0.9% Sodium chloride 20 mol/kg as a slow infusion.

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 Note

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  • Do not administer IV fluids in case of cardiogenic shock but maintain IV line

  • If patient develops respiratory distress, discontinue fluids but maintain IV line

  • Septicemia in children: All children with shock which is not obviously due to trauma or simple watery diarrhea should receive antibiotic cover for probable septicemia. Give ceftriaxone, IM, 50–80 mg/kg/dose immediately as a single dose.

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CAUTION !

  • Do not administer calcium containing fluids, e.g. Ringer Lactate, within 48 hours of administering ceftriaxone

  • Contra-indicated in neonatal jaundice

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note dose and route of administration on referral letter.

 

Updated on, 26.10.2020

 

References

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1. STG page number 6-7-8

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