Shock is not just a dramatic medical word. It’s a real, critical condition where the body’s tissues are starved of oxygen and nutrients. If not reversed quickly, it leads to multiple organ failure and death. This article breaks down everything you need to know about shock—from its various types to signs, causes, and emergency treatments.
What is Shock?
Shock is a state of acute circulatory failure that leads to inadequate tissue perfusion, causing cellular hypoxia, energy failure, and ultimately organ dysfunction. It’s a time-sensitive emergency where every minute counts.
Types of Shock
Shock can be broadly classified into:
- Hypovolaemic Shock
- Cardiogenic Shock
- Septic Shock
- Anaphylactic/Distributive Shock
- (Others include neurogenic and obstructive)
Each type has distinct causes, pathophysiology, and management protocols.
1. Hypovolaemic Shock
Causes:
- Blood loss: Trauma, GI bleed, ruptured aneurysm
- Plasma loss: Burns, pancreatitis
- Fluid loss: Vomiting, diarrhea, intestinal fistula
Clinical Features:
- Pallor, cold extremities
- Sweating, anxiety, rapid breathing
- Weak, thready pulse
- Low systolic BP, oliguria
Visual Insight:
The diagram shows a graph of systolic blood pressure drop over time in untreated vs. treated haemorrhage. Without early treatment, patients spiral into catastrophic decline.
2. Septic Shock
Definition:
Septic shock occurs when sepsis leads to profound circulatory, cellular, and metabolic abnormalities—despite fluid resuscitation.
Pathophysiology:
- Gram-negative bacteria (e.g., E. coli) release lipopolysaccharide (LPS) endotoxins
- Neutrophil activation → phospholipase A₂ → cytokine storm
- Complement & mast cell degranulation → capillary leak, vasodilation, V/Q mismatch
Two Types:
Type I (Warm Shock):
- Flushed skin, bounding pulse
- Vasodilation with redistribution of blood flow
Type II (Cold Shock):
- Pale, clammy skin
- Low BP, confusion, oliguria
Progression:
As shock worsens → myocardial depression, lactic acidosis, capillary leak → multi-organ failure
3. Cardiogenic Shock
Causes:
- Myocardial infarction (MI)
- Arrhythmias (AF, VT)
- Cardiac tamponade
- Valve diseases
Symptoms:
- Cold, clammy skin
- Hypotension, weak pulse
- Cyanosis, confusion
- Elevated JVP (in tamponade)
Management:
- Inotropes (e.g., dobutamine)
- Revascularization (PCI in MI)
- Correct underlying rhythm or valve issue
4. Anaphylactic (Distributive) Shock
Trigger:
An IgE-mediated hypersensitivity reaction to allergens (e.g., drugs, peanuts, bee sting)
Features:
- Dyspnea, stridor
- Flushed skin, urticaria
- Swelling (angioedema)
- Hypotension and collapse
Treatment:
- Epinephrine IM immediately
- Antihistamines, corticosteroids
- Airway support and IV fluids
Clinical Diagnosis of Shock
Initial Assessment:
- Vital signs: BP, HR, RR, temperature
- Skin: Pale, cold, mottled in hypovolaemic or cardiogenic; flushed in septic shock
- Mental status: Confusion, agitation, drowsiness
- Urine output: <0.5 mL/kg/hr is alarming
Investigations & Bedside Monitoring
- CBC, U&E, creatinine
- Blood cultures (sepsis)
- Arterial blood gases
- Lactate levels
- ECG and troponins (cardiogenic)
- Echo/USG (tamponade, volume status)
Emergency Management of Shock
1. Airway and Breathing
- Secure airway
- Give high-flow oxygen (target SpO₂ >94%)
2. Circulation
- Establish IV access
- Start IV fluids—crystalloids (20 ml/kg bolus)
- Consider vasopressors if hypotension persists (e.g., noradrenaline)
3. Specific Treatments
| Type of Shock | Specific Therapy |
|---|---|
| Hypovolaemic | Stop bleeding, fluid resuscitation |
| Cardiogenic | Inotropes, cardiac support |
| Septic | Broad-spectrum IV antibiotics, source control |
| Anaphylactic | IM adrenaline, fluids, steroids, antihistamines |
Key Clinical Pearls
- Always identify the cause and treat early
- Hypovolaemia is most common in surgical settings
- Persistent shock despite fluids = likely need for ICU
- Septic patients may appear well initially—vigilant monitoring is essential
Common Mistakes to Avoid
- Delaying fluid resuscitation while awaiting test results
- Overlooking sepsis in afebrile or elderly patients
- Missing subtle signs of cardiogenic or tamponade shock
- Relying solely on BP—mental status & urine output are key early indicators
Complications of Untreated Shock
- Acute renal failure (ATN)
- Hepatic failure
- ARDS (especially in septic shock)
- Coagulopathy (DIC)
- Acalculous cholecystitis
- SIRS → MODS → Death
Shock in Surgical and ICU Patients
- Postoperative shock may present subtly
- Restlessness, low urine output, or confusion may be early signs
- ICU protocols should include hourly vitals, fluid charting, and daily infection screens
Summary Table: Types of Shock
| Type | Key Feature | Initial Management |
|---|---|---|
| Hypovolaemic | Fluid/blood loss | Fluids + control source |
| Cardiogenic | Heart pump failure | Inotropes + cardiac intervention |
| Septic | Infection + vasodilation | Antibiotics + fluids |
| Anaphylactic | Allergic reaction | Adrenaline + airway support |
FAQs on Shock
1. What’s the first line of treatment for shock?
Airway, oxygen, and IV fluids. Stabilize first, then investigate.
2. Can shock be reversed?
Yes, if identified and treated early.
3. What is warm vs. cold shock?
Warm shock (e.g., early sepsis) has flushed skin; cold shock (late sepsis, hypovolaemia) has cold, clammy skin.
4. Why is urine output important in shock?
It reflects kidney perfusion. <0.5 ml/kg/hr indicates poor circulation.
5. What tests confirm shock?
It’s primarily clinical, supported by lactate, ABG, and organ function tests.
Conclusion
Shock is a medical emergency that demands swift recognition and action. Whether it's blood loss, infection, cardiac failure, or allergic reaction—time is the enemy. Mastering the types, signs, and emergency management of shock can mean the difference between life and death.
Recognize the signs. Start resuscitation. Save lives.
