Shock

Shock is commonly diagnosed when signs of hypoperfusion are associated with low or declining blood pressure.

The patient with shock will look ill and often have symptoms specific to the underlying cause (e.g., fever, chest pain, shortness of breath, abdominal pain, or altered mental status). This may be difficult to recognize in practice.

Shock 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, vasoactive agents 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.

This topic focuses on the diagnosis and management of shock in adults; ​​the diagnosis and management of shock in children is beyond the scope of this topic.

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 damage to vital organs 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]Cecconi M, De Backer D, Antonelli M, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014 Dec;40(12):1795-815. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4239778 http://www.ncbi.nlm.nih.gov/pubmed/25392034?tool=bestpractice.com [2]Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021 Nov;47(11):1181-247. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8486643 http://www.ncbi.nlm.nih.gov/pubmed/34599691?tool=bestpractice.com [3]McDonagh TA, Metra M, Adamo M, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-726. https://academic.oup.com/eurheartj/article/42/36/3599/6358045 http://www.ncbi.nlm.nih.gov/pubmed/34447992?tool=bestpractice.com