Shock

Clinical Description

Acute circulation failure resulting in inadequate tissue perfusion and cellular hypoxia, generally with a low blood pressure.

This is a medical emergency which needs to be promptly treated. Causes are;

• Hypovolemic (hemorrhage, cholera, severe vomiting, diabetic ketoacidosis)
• Cold, clammy skin; weak pulse,
• tachycardia
• Cardiogenic (myocardial infarction, abnormal heart rhythm)

Signs of heart failure, tachycardia or bradycardia – for treatment see heart failure section

• Obstructive (pericardial tamponade, tension pneumothorax)
• Raised jugular venous pulse, pulsus paradoxus
• Distributive (sepsis, anaphylaxis, neurogenic)
• May have hyperthermia or hypothermia, tachycardia, altered mental status

Important emergency assessment: Is there a pulse?

• If no pulse, start CPR
• Give Adrenaline immediately and every 4 minutes: 0.1 ml/kg of 1:10,000 IV/IO
• If able to assess the cardiac rhythm, a defibrillator is available, and staff are trained to use
• Shockable rhythm identified (VF or pulseless VT)
• DC shock 4 J/kg every 2 minutes
• Continue CPR
• Give Adrenaline every 4 minutes 0.1 ml/kg of 1:10,000 IV/IO
• Give Amiodarone 5 mg/kg IV/IO after 3rd and 5th shock

If there is a pulse assess for signs of shock = a mismatch between circulatory supply and tissue demand

• Cold peripheries
• Capillary refill time >3 seconds
• Weak thready peripheral pulse