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Treatment of Shock, Hypovolemic shock, Neurogenic shock, Monitoring of…
Treatment of Shock
Shock may be defined as a clinical state of circulatory failure characterized by hypoxia of cells due to inadequate capillary (tissue) perfusion.
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The features of common type of shock in clinical practice are hypovolemia, hypotension, increased pulse rate, reduced Cardiac output and metabolic acidosis
Hypovolemic shock
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Fluid replacement: Replacement of fluid is required at the earliest depending on type of fluid lost.
Appropriate fluid replacement is prerequisite and mainstay of treatment (life saving) to overcome the shock and even before using the drugs.
Drugs: Dopamine is the drug of choice to maintain the perfusion of vital organs as it dilates renal and mesenteric blood vessels.
The doses used should be lower to stimulate dopamine receptors and to prevent the stimulation of alpha-receptors.
Vasopressor agents should be avoided as already there is intense reflex vasoconstriction and use of vasopressor agent will aggravate the condition.
The alpha-blockers e.g. Phenoxybenzamine or phentolamine can be used to counteract vasoconstriction due to increased sympathetic activity
and to maintain the perfusion of vital organs.
Neurogenic shock
Thus agents such as noradrenaline, methoxamine, mephentermine and phenylephrine, are indicated.
There is hypotension due to paralysis of sympathetic system and headache is due to both hypotension and leakage of CSF in cases of spinal anaesthesia.
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The BP has to be maintained with drugs, if required.
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These are the conditions where vasopressor agents are required as there is sympathetic dysfunction,
due to which there is pooling of blood in postcapillary capacitance vessels leading to hypotension.
Such changes may occur in cases of spinal anaesthesia, spinal injury, abdominal injury and perforation of a hollow viscus etc.
In case of spinal injury and other cases, if there is hypotension it is due to paralysis of sympathetic system and thus should be treated with vasopressor agents
And appropriate drugs for other complications including blood transfusion, if significant amount of blood is lost.
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Specific treatment
Specific treatment: Specific treatment depends on type of shock. Moreover, cause of fluid loss should be treated.
Example: Antiemetic for vomiting, Antidiarrhoeal for diarrhoea.
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Similarly, if it is hemorrahge due to road side accidents, the wound debridement, dressing, antibiotic and analgesic (morphine) should be used.
Anaphylactic shock
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It is acute hypersensitivity reaction (type 1 allergic reaction) due to certain drugs e.g. Penicillin G in sensitive individuals.
There is release of histamine and other mediators leading to bronchospasm, hypotension, and laryngeal oedema and condition is potentially fatal if not managed promptly.
The mainstay and lifesaving treatment is adrenaline and adjuvant is antihistaminics and corticosteroids.
Cardiogenic shock
Cardiogenic shock: Usually this is due to or after attack of myocardial infarction (MI) or in acute myocarditis.
And thus the inotropic agents such as dobutamine/dopamine should be used apart from other specific measures.
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Septic shock
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So, aim of treatment is to control and eradicate infection by using appropriate antimicrobial agents apart from general supportive and symptomatic treatment as early as possible.
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Distributive sock
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It is inadequate perfusion results due to abnormal distribution of blood flow in smallest blood vessels.
Angiotensin II is approved by US-FDA to be used to increase blood pressure with septic or other distributive shock in adults.
Summary
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Hypovolaemic – Fluid replacement, dopamine
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Neurogenic shock – Vasopressor agents (mephentermine, methoxamine)
Cardiogenic shock – dobutamine, dopamine
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