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Shock

Última revisão: 20 Aug 2025
Última atualização: 22 Jul 2025

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • presencia de factores de riesgo
  • consciencia alterada/agitación
  • hipotensión
Detalhes completos

Outros fatores diagnósticos

  • taquipnea
  • taquicardia
  • tiempo prolongado de llenado capilar
  • oliguria
  • debilidad muscular
  • cianosis
  • extremidades frías
  • evidencia de traumatismo
  • erupción petequial
  • dolor torácico
  • fiebre
  • dolor abdominal
  • distensión venosa yugular
  • edema periférico
  • ausencia de sonidos de la respiración de un lado del tórax
  • desviación de la tráquea
  • ruido cardíaco de bajo tono
  • parálisis flácida de las extremidades inferiores
  • soplo cardíaco
  • vejiga distendida
  • inflamación de cara y lengua
  • urticaria
  • dolor pélvico/sangrado vaginal en mujeres en edad fértil
Detalhes completos

Fatores de risco

  • mayor edad
  • comorbilidades
  • infarto de miocardio
  • cardiomiopatía
  • enfermedad de válvula cardíaca
  • arritmias
  • traumatismo
  • sangrado gastrointestinal
  • rotura de aneurisma aórtico abdominal
  • quemaduras/golpes de calor
  • pérdidas gastrointestinales: diarrea y vómitos
  • pancreatitis
  • sepsis
  • anafilaxia/envenenamiento
  • lesión de la médula espinal o del tallo cerebral
  • enfermedad endocrina
  • embolia pulmonar
  • taponamiento cardíaco
  • nuevos medicamentos (shock anafiláctico)
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • lactato (gasometría arterial)
  • gasometría
  • hemograma completo (HC)
  • urea y creatinina
  • electrolitos séricos
  • estudios de coagulación (índice internacional normalizado [INR], tiempo de tromboplastina parcial activada [TTPa])
  • glucemia
  • anión gap
  • proteína C-reactiva
  • procalcitonina
  • electrocardiograma (ECG)
Detalhes completos

Investigações a serem consideradas

  • radiografía de tórax
  • exploración de evaluación enfocada con sonografía para traumatismo (FAST)
  • ecocardiografía
  • dióxido de carbono tidal final (capnografía)
  • ultrasonido del tórax
  • ultrasonido de abdomen
  • tomografía computarizada (TC) de tórax, abdomen y pelvis
  • angiografía pulmonar por tomografía computarizada
  • análisis de orina y prueba de embarazo en orina
  • ultrasonido pélvico
  • radiografía de los huesos largos
  • radiografía de la columna vertebral
Detalhes completos

Algoritmo de tratamento

AGUDA

todos los pacientes

Colaboradores

Autores

Samuel J. Stratton, MD, MPH
Samuel J. Stratton

Professor

Fielding School of Public Health

David Geffen School of Medicine at UCLA

Los Angeles

Deputy Health Officer

Orange County Health Care Agency

Health Disaster Management/Emergency Medical Services

Santa Ana

CA

Declarações

SJS declares that he has no competing interests.

Agradecimentos

Dr Samuel J. Stratton wishes to gratefully acknowledge Dr Christoph Pechlaner and Dr Christian Wiedermann, previous contributors to this topic.

Declarações

CP and CW declare that they have no competing interests.

Revisores

Patrick Nee, FRCP, FRCS, FCEM

Consultant in Accident & Emergency Medicine

St Helens & Knowsley Hospitals NHS Trust

Whiston Hospital

Prescot

UK

Declarações

PN declares that he has no competing interests.

James Brown, MD, MMM

Vice-Chair and Program Director

Wright State University Department of Emergency Medicine

Dayton

OH

Declarações

JB declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

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.Texto completo  Resumo

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.Texto completo  Resumo

McDonagh TA, Metra M, Adamo M, et al; ESC Scientific Document Group. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-726.Texto completo  Resumo

Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022 May 3;79(17):e263-421.Texto completo  Resumo

van Diepen S, Katz JN, Albert NM, et al. Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association. Circulation. 2017 Oct 17;136(16):e232-68.Texto completo  Resumo

Artigos de referência

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