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Shock

In medicine, shock (hypoperfusion) is a life-threatening medical emergency characterized by inability of the circulatory system to supply enough oxygen to meet tissue requirements. Hypotension is usually, though not always, present. Without prompt medical treatment, shock usually causes death. more...

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Types of shock

  • Hypovolemic shock. The single most common cause of shock is blood volume loss, resulting from a serious wound or a severe burn leading to hypovolemic shock. This may also be referred to as haemmorhagic shock.
  • Cardiogenic shock is caused by the failure of the heart to pump effectively. This can be due to damage to the heart muscle, most often from a large myocardial infarction. Other causes of cardiogenic shock include arrhythmias, or cardiac valve problems.
  • Distributive shock. As in hypovolemic shock there is an insufficient volume of blood. This form of relative hypovolaemia is the result of dilation of bloodvessels. Examples of this form of shock are:
    • Septic shock is caused by overwhelming infection leading to vasodilation. It is treated by antibiotics, fluid replacement, and vasoconstrictors.
    • Acute adrenal insufficiency is not infrequently the result of discontinuing corticosteroid treatment without tapering the dosage.
    • Less commonly severe anaphylactic reactions may cause anaphylactic shock as allergens trigger widespread vasodilation and movement of fluid out of the blood into the tissues.
    • The rarest cause of shock is acute spinal cord injury leading to neurogenic shock. Neurogenic shock is caused by the sudden loss of the sympathetic nervous system signals to the smooth muscle in vessel walls. Without this constant stimulation the vessels relax resulting in a sudden decrease in peripheral vascular resistance and decreased blood pressure.
  • Obstructive shock. Hereby the flow of blood is obstructed. Several conditions result in this form of shock.
    • Cardiac tamponade, in which blood in the pericardium prevents inflow of blood into the heart (venous return). Or constrictive pericarditis which has the same effect.
    • Tension pneumothorax. Through increased intrathoracic pressure bloodflow to the heart is prevented (venous return).
    • Massive pulmonary embolism is the result of a thromboembolic incident in bloodvessels of the lungs and hinders the return of blood to the heart.

Symptoms and signs

The external signs and symptoms of shock are:

  • feeling of thickness, weakness, thirst;
  • pallor, especially visible at the inner side of the lips when the casualty has a dark skin;
  • rapid pulse (tachycardia, more than 120 beats per minute), the radial pulse is difficult to feel;
  • when pressing a finger nail, it takes more than two seconds for the color to come back;
  • confusion or anxiety;

Other signs can be evaluated:

  • decreased urine production
  • low blood pressure.

Patients with hypovolaemic or cardiogenic shock will have cold and clammy hands and feet. Septic, anaphylactic and neurogenic shock may present with warm extremities.

Read more at Wikipedia.org


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Mycobacterium tuberculosis an unusual yet highly fatal cause of septic shock
From CHEST, 10/1/05 by Raquel Nahra

PURPOSE: To describe a group of patients with septic shock caused by M. Tuberculosis and compare their outcomes to those of patients with septic shock caused by other microorganisms.

METHODS: Data was extracted from a multicenter database with information from the records of 2731 patients with septic shock. Patients with septic shock caused by M. Tuberculosis were identified by positive blood or multi-site cultures.

RESULTS: A total of 2731 patients with septic shock were studied. Eleven patients (0.4%) had septic shock caused by M.Tuberculosis (MTB group). In the MTB group, the mean age was 44.2 ([+ or -] 19.5) years, mean APACHE II score was 26 ([+ or -] 8), 36% were males and 64% were females. Comorbid conditions included; alcohol use 54%, non-HIV immunosupresive diseases 36.4%, and diabetes mellitus 18.2%. None of these patients had documented HIV. Overall mortality in the MTB group was 81.8 %, and mean length of stay in the ICU was 12.7([+ or -] 17.1) days. Inapropriate initial antimicrobial coverage based on culture results was given to five patients (45.5%) in the MTB group. When compared to patients with septic shock caused by other microorganism (OTH group), patients in MTB group were younger (44.27([+ or -] 19.5) years vs 62.66 ([+ or -] 16.4)) years p = 0.0002), and more likely to have alcohol use as a comorbidity (54.4% vs 13.8 %, p= 0.0013). Patients in the MTB group were more likely to receive inappropriate initial antimicrobial therapy than patients in the OTH group (45.5% vs 18.6%, p=0.0039). Patients in the MTB group had a higher mean ICU LOS (12.21 days vs 8.1 days), had a higher overall mortality (81.8% vs 56.2% , p = 0.12), and were more likely to develop hepatic failure (p 0.0039).

CONCLUSION: M. Tuberculosis is an uncommon cause of septic shock. However, when it occurs it is associated with increased morbidity and mortality and a significant delay in institution of appropriate antituberculous treatment.

CLINICAL IMPLICATIONS: Mycobacterium Tuberculosis should be thought of as a possible cause for septic shock in apropriate clinical situations.

DISCLOSURE: Raquel Nahra, None.

Raquel Nahra MD * Sergio L. Zanotti-Cavazzoni MD Anand Kumar MD Cooper University Hospital, Camden, NJ

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group

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