Wednesday, August 14, 2013

facts about medical shock

               On 13/8/13 our college conducted an academic carnival on medical shock. Don't confuse it with electric shock because both medical shock and electric shock are different. First what is shock? It is the life threatening condition i.e. imbalance between the circulation and pumping mechanism. There are many types of shock. They were cardiogenic, traumatic, neurogenic, hypovolemic, anaphylactic (allergy) and septic shock (infection due to micro-organism). If the shock is not treated immediately then it will cause multi organ dysfunction and sudden death will occur.

                First I discuss about septic shock. It will attack any age group and it is due to infection by microorganisms. The most common age group is children under 5 years of age in the world. The reason for the septic shock is interruption in the anatomical barriers (skin, wound, fundus, ENT, rectal, vaginal and orifice). Do you know that our blood is a sterile fluid and it does not contain any normal flora. To prevent septic shock, first you want to control infection and use prophylactic antibiotic therapy. The early recognition of patients at high risk of septic shock will cure them and that helps to save their life from death. Some useful websites for more information about septic shock are 1) www.ccforum.com 2) www.atsu.edu 3) www.sepsis.com 4) www.ncbi.nlm.nih.gov.

                The spinal shock (loss of reflex) and the neurogenic shock are different. In neurogenic shock the sympathetic system ( thoraco-sacral out flow) has been cut off. This will go for bradycardia because the parasympathetic (cranio-sacral out flow) will be dominant.

                 In anaphylactic shock, the acute anaphylactic reaction is an uncommon but well recognized cause of sudden death. Some agents are skin contact (poison plants, animal scratches, pollen and latex), injection ( honey bees-Bee sting). At autopsy, the serum tryptase level cannot be determined in anaphylactic shock, but eye witness and records can be useful in determining the cause of death.

                 In burn shock, our body overcomes the shock by increasing the head pressure, increasing the pumping rate of heart and by diverting the fluid from less important to highly important regions. Do you know? Our skin is the largest organ and it covers about 1.8 square meters and has the maximum blood supply. The pathophysiology of burn shock is loss of fluid, proteins and electrolytes. The treatment is given IV fluid immediately, then electrolytes immediately and later the proteins should be injected in the body blood.

                 The management of shock in severe sepsis i.e. systemic inflammatory respond syndrome (SIRS) + infection + organ dysfunction + hypotension. The approach to a case of undifferentiated shock are

- History or evidence of trauma
- Search for bleed, volume loss (vomiting, diarrhea)
- Examine for fever or hypothermia
- ECG evidence for ischaemia
- Unexplained bradycardia or hypotension
- Unexplained hypoxemia
- Abdominal or low back pain caused due to dissection of the aorta
- Skin hives, mottling, flushing. These are the features of sepsis.
- Wheezing

                The more recent treatments are

- Use of heparin (which is the evidence based medicine). The dosage may differ in adult burn and pediatric burn)
- Use of collagen sheet (which reduces evaporative loss and pain)
- Homografting
- Controlled use of antibiotics because it will cause pathologic emergency due to unabsorptive of antibiotic in the gastrointestinal tract.
- supports nutrition.
- Enzyme debridement will digest the dead tissues and the surgical removal becomes easy and helps in early skin grafting.

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