Shock

Commonly diagnosed when signs of hypoperfusion are associated with low or declining blood pressure.

It may result from a number of disease processes, including pump failure (cardiogenic), loss of intravascular volume (hypovolemic), failure of vasoregulation (distributive), or obstruction to blood flow (obstructive).

Initial treatment aims to optimize oxygen delivery and reverse hypoperfusion through volume resuscitation, vasopressors for refractory hypotension due to vasodilation, management of cardiac dysfunction, and treatment of the underlying cause.

Management of shock is best undertaken in a critical care environment.

Shock is most commonly defined as the life-threatening failure of adequate oxygen delivery to the tissues and may be due to decreased blood perfusion of tissues, inadequate blood oxygen saturation, or increased oxygen demand from the tissues that results in decreased end-organ oxygenation and dysfunction. If left untreated, shock results in sustained multiple organ dysfunction, and end-organ damage with possible death. Tissue hypoperfusion may be present without systemic hypotension, but at the bedside shock is commonly diagnosed when both are present (arterial hypotension and organ dysfunction). [1] Antonelli M, Levy M, Andrews PJ, et al. Hemodynamic monitoring in shock and implications for management: international consensus conference, Paris, France, 27-28 April 2006. Intensive Care Med. 2007 Apr;33(4):575-90. http://www.ncbi.nlm.nih.gov/pubmed/17285286?tool=bestpractice.com [2] Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock - 2016. Intensive Care Med. 2017 Mar;43(3):304-77. http://www.ncbi.nlm.nih.gov/pubmed/28101605?tool=bestpractice.com [3] Nieminen MS, Böhm M, Cowie MR, et al. Executive summary of the guidelines on the diagnosis and treatment of acute heart failure. Eur Heart J. 2005 Feb;26(4):384-416. http://eurheartj.oxfordjournals.org/cgi/content/full/26/4/384 http://www.ncbi.nlm.nih.gov/pubmed/15681577?tool=bestpractice.com [4] Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Fail. 2016 Aug;18(8):891-975. http://onlinelibrary.wiley.com/doi/10.1002/ejhf.592/full http://www.ncbi.nlm.nih.gov/pubmed/27207191?tool=bestpractice.com