Shock: Types and Treatments - Reeve Foundation

Shock is a medical term that is heard often. When it occurs, it is a medical emergency. There are several types of shock, including distributive shocks, which include septic shock, anaphylaxis shock, and spinal shock. There is also hypovolemic shock, cardiogenic shock, and obstructive shock. Each has its own set of issues and concerns.

The term shock is the inadequate blood flow that creates a situation in which oxygen and nutrients cannot reach the body’s cells. This leads to hypoxia (lack of oxygen) at the cellular level, which creates cell death. When enough cells in a part of the body die, organ dysfunction occurs, which leads to the death of an individual. This is a very serious condition.

In stage I of shock, the body will first try to compensate by keeping blood pressure within normal limits. This is accomplished by constricting blood vessels in the periphery of the body, which enhances blood flow to vital organs. Heart rate and contraction strength are increased, as is respiration, and there is a release of epinephrine and norepinephrine (catecholamines) through stimulation of the sympathetic nervous system. The extremities become cool due to the blood shift, the bowel becomes less active, and urine output decreases as the body conserves. The individual has behavior changes and is confused or even unconscious.

Stage II of shock is progressive as the body becomes unable to compensate. Blood pressure lowers from the individual’s normal, and respirations become shallow, leading to increased carbon dioxide in the blood, a heartbeat even faster, and chest pain and edema. They may have diarrhea, renal failure, jaundice, and blood work will be elevated, especially in kidney and liver factors. The individual will be increasingly lethargic at this point.

Stage III of shock is a refractory phase of irreversible damage to body organs. Tissue toxins are released. The individual is unconscious. With ongoing organ dysfunction and failure, death occurs.

The treatment for generalized shock is to provide I.V. crystalloids that can enter the cells and colloids that will pass through the capillaries. Medications to increase heart contractions and vasoconstriction to improve heart and blood vessel function are required. The individual must be monitored extremely carefully in an ICU setting.

The Distributive Shock category is called because the distribution of blood is affected. The blood vessels are dilated, which leads to inadequate blood profusion. There are three types of shock in this group, septic, anaphylaxis, and neurogenic.

Septic Shock is one of the most common conditions that follow the basic shock outline above. It occurs when an infection, either diagnosed or undiagnosed, spreads throughout your body. The stages above are the pathway of septic shock. This is a very serious condition, especially with neurological disease or injury, as you may not have sensations to notice early symptoms. If it is caught early when an infection turns into sepsis (spreading throughout your body), the odds of being able to treat sepsis are far better than if the infection develops into septic shock. Note the symptoms above and call 911 if you suspect sepsis or septic shock. Here is more information about sepsis. Keep several copies of the wallet card to present this care to the ambulance EMTs, at the emergency room, and in the hospital. Keep sepsis in all the healthcare provider’s minds as you want them to evaluate for sepsis early.

Anaphylaxis shock is known by most individuals, even if never seen. It occurs when a person has exposure to an allergy resulting in an extremely severe reaction. Often people will know about an allergy and will avoid it, but some people have allergies that they may not know about. For instance, people may know about an allergy to peanuts and avoid them. They may not know they are allergic to bee stings until they are stung.

Latex can be an allergy that can lead to anaphylaxis shock. It develops over time. This includes exposure to medical equipment that touches the skin, such as gloves and catheters that contain latex. It can develop into an allergy not only due to exposure of the equipment to the mucous membranes of the urethra and rectum but also to inhaled latex dust which forms during manufacturing. Nurses and doctors get latex rashes on their skin from stethoscopes around their necks, so they put them in their pockets or cover them with a cloth. Latex balloons are not allowed in pediatric facilities because the risk of touching the balloons or breathing latex dust is too great for children with chronic health conditions. Most medical equipment has latex removed now. However, be sure your products have ‘latex free’ on the packaging. There are some latex products still sold at bargain prices, so buyer beware!

Anaphylaxis can occur within seconds or minutes. The individual may have a sudden rash, low blood pressure, difficulty breathing, fast pulse, nausea or vomiting, and dizziness. If the individual has an EpiPen, it is time to administer it to the thigh. Call 911. It is an emergency situation.

Neurogenic shock occurs after a spinal cord injury at the cervical or thoracic level and from trauma. It is also found in some cases of brain injury, Gillian Barré, transverse myelitis, and other neuropathies. This type of shock is a bit different as you have a slow heart rate, and temperature control issues, and your hands, arms, feet, and legs are warm. Spinal stabilization, fluids, and medications to control your cardiac function are needed. Neurogenic shock stabilizes in the body but can last up to five weeks or quite a bit longer. This can make the transition to home a bit more unsettling as your total post-spinal cord injury function is not established until neurogenic shock resolves.

Spinal shock is a term heard with spinal cord injury, not to be confused with neurogenic shock. It is the state of the body immediately after a spinal cord injury of paralysis, loss of sensation, loss of bowel and bladder function, and loss of reflexes. It is a ‘shock’ to the spinal cord, but not a metabolic shock as the others listed in this blog.

Hypovolemic shock occurs when blood volume is low (hypo=low, volemic=volume). This can occur from severe bleeding, burns, trauma, blood being shunted into major organs, kidney issues, or excessive gastrointestinal loss (as in a bleeding ulcer in the bowel or stomach or diarrhea over time).

Symptoms include increased heart rate. You may see the jugular vein in the neck pulsing. Hands, arms, legs, and feet will be cold. Hypovolemic shock most often occurs quickly. However, in some individuals, including those with neurological disease, it can evolve more slowly over time as a lack of adequate hydration, vomiting, or a bleeding gut without signs that the individual can notice.

Hypovolemic shock should not be confused with orthostatic hypotension but if there is a question between the two, call 911. Treatment is I.V. fluids and blood replacement.

Cardiogenic shock is caused by dysfunction of the heart. Your heart is just not able to pump enough blood and, therefore, oxygen and nutrients around your body, especially to your vital organs. Symptoms include an increased heart rate, pounding jugular veins in the neck, and cold hands, arms, legs and feet, among others. Typically, this problem arises due to heart issues such as a heart attack, arrhythmias (irregular heartbeats), or atrial or mitral valve issues.

The signs of cardiogenic shock are like a heart attack with chest pain, pain in your shoulder, or back, with neurological injury, you may not feel pain, but it may be referred to your jaw. Also, you may be short of breath, lightheaded or dizzy, sweaty, and have nausea or vomiting. Call 911, as you will need intensive care to stabilize your heart.

Obstructive shock is an issue with your circulation (arteries and veins), which does not allow your heart to pump blood effectively through your body. Heart rate is fast, jugular veins are pulsing, and your hands, arms, feet, and legs are cold. This can happen if a blood clot reaches your lung, especially if you have a neurologic disease or injury. Other causes include pneumothorax (collapsed lung or air embolism), an infection around your heart, or a heart that is not beating well.

Although this is one of the most survivable shocks, you still will require intensive care treatment and perhaps surgery to remove the obstruction to your circulatory system.

Therefore, the bottom line is if you find a person has changes in heart rate, pounding jugular veins in the neck, body temperature changes, or mental status changes, it is time to check for shock. Call 911. It is imperative that the individual receives immediate treatment.

Pediatric Consideration:

Shock in adults is an extremely critical condition. In the pediatric population, it is even more significant as the pediatric body does not have as much leeway for compensation. Adults have little, children even less. For instance, in the case of gastrointestinal bleeding, children are more susceptible to bacteria in the gut and have about 1-2 hours of rehydration. This is why Respiratory Syncytial Virus (RSV) is more of an issue in children (and the elderly) than in adults. The same for sepsis. Internal bleeding, especially with nervous system disease or injury in the brain or spinal cord, can occur much faster.

Knowing your child’s behaviors and issues provides you with the ability to get your child the help they need quickly. The ability to stave off these issues is possible with early intervention.