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DirtyHarry

Shock Question

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No not the Shocker!!!

 

So, in reading about the unfortunate accident at Si, the poster noted that the climber was treated for shock, but only had fairly minor cuts and bruises, and a broken arm. I was under the impression that shock is a result of the body not being able to pump enough blood to organs and extremities, as a result of blood loss from trauma, etc. However, it appears that this gentleman cleary had not lost any or much blood. Am I wrong avbout what causes shock and what shock is? Can any medico types help me out?

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You are right that while in shock, a person's circulatory system will prevent blood from going to the extremities at a normal flow rate (hence the coldness that a person feels). However, it does go to the organs--that is why extremity flow goes down--to save the organs and keep them oxygenated.

 

And as CBS said, blood loss is not necessary. Shock can be induced through mental trauma. The body has a hard time differentiating between the two. I can ask my best friend Cari, a physician, why this is so (unless someone else can answer here before I get to her)

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In shock the blood vessels dilate leading to a drop in blood pressure. Death comes as a result of not enough blood to the brain. Shock can be induced merely from pychogenic trauma.

 

The treatment is to elevate the extremities and keep the patient warm. To say that the victim here was treated for shock isn't to say necessarily he suffered from shock but that they took the standard precautions to prevent it from happening.

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Shock is a general term for inadequate cardiovascular function. It can be thought of in layman's terms as "not having enough fluid (blood) in the pipes (vessels and heart)" to maintain enough pressure to adequtely circulate fluid thorughout the system.

 

It can be caused by many things.

 

The three types related to trauma are:

Hypovolemic shock: blood loss. Not enough fluid in the pipes due to a leak of fluid.

Neurogenic shock: damage to central nervous system which controls blood pressure, HR, vascular tone, etc. causing subsequent drop in blood pressure. The pipes dilate, thereby becoming bigger, and then there isn't enough blood to fill them and generate enough pressure to get good perfusion.

Psychogenic shock: I don't understand the physiology behind this one very well, but I think of it as a Neurogenic shock induced by a psychological trauma. The end result is the same. Nervous system dysfuction causes vessels to dilate. Big pipes, not enough fluid = low pressure.

 

Psychogenic shock is very common and was the most likely form of shock the individual in the Little Si incident was experiencing.

 

Basic treatment for these types of shock includes: controlling bleeding, positioning patient with feet raised (don't do this if they have head trauma) which increases blood volume+pressure in the torso+head, keeping the patient warm, reassuring/comforting patient (especially important for psychogenic shock), administering oxygen, and packaging and transporting to hospital.

 

There are other forms of shock... anaphylactic, septic, etc.

 

GOOD LINK

 

 

 

Another good link explaining physiological of BP regulation

LINK 2

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In shock the blood vessels dilate leading to a drop in blood pressure. Death comes as a result of not enough blood to the brain. Shock can be induced merely from pychogenic trauma.

Hi CBS,

 

Are you saying that psychogenic shock can be fatal? If so, I'd be interested to see a reference to a case in the literature, as I couldn't seem to find one. My layperson's understanding was that psychogenic shock leads to fainting, at worst. This is in contrast to hypovolemic, septic, neurogenic, or anaphalactic shock which can all be fatal. Is that not correct?

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I don't know the specifics of this case, but I was a fire department paramedic until recently and can say two things-

1. Everything Alpinfox said is exactly the way i learned it in school and observed it in the field.

2. People with normal blood pressures who are too upset to function well are often described (by themselves, bystanders or news media) as being "in shock."

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no, you can't die from psychogenic shock, you could die from the potential sequalae however, mainly a heart attack, or from being injured while passing out.

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Are you saying that psychogenic shock can be fatal?

 

So after the bombing of the british consulate in istanbul, a perfectly healthy woman turned around the corner and looked at the carnage. She collapsed and almost died--if there hadn't been a doc with an iv next to where we were standing, I think she would've died. She was out of the blast wave, and had no concussive damage, just freaked the hell out when she saw what had happened.

 

But as layton says, it was the things that follow on the shock that actually would have killed her.

 

I'm sure it's happened a whole bunch.

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Shock was always a very confusing topic to me, until a paramedic friend once defined it as "inadequate perfusion." It's that simple.

 

There is also a fourth kind of shock in addition to those alpinfox listed above, cardiogenic shock. This is basically reduced cardiac output secondary to some sort of heart disease or trauma. Examples: myocardial infarction, congenital heart disease, drug toxicity, pericardial tamponade, traumatic injuries, arrythmia, septic shock, and many other sources.

 

In other words, the body is not adequately perfused because the pump has failed.

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it's like a goddamn wfr recert in here ugh

 

Early signs of shock include pale/cold/clammy skin, shallow/rapid breathing, and a weak/fast pulse. Perhaps reduced level of consciousness.

 

Important to note differences from patients with increased intracranial pressure (closed head injury): slow/bounding pulse and possible irregular breathing.

 

First the body is trying to compensate for inadequate perfusion and maintain blood pressure. Increased breathing/heart rates and shunting blood from the periphery accomplish this.

 

Eventually the body is unable to maintain blood pressure. Informally, this means the body is in deep shit and likely can't dig itself out without serious help (ALS, IVs).

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Psychogenic shock: I don't understand the physiology behind this one very well, but I think of it as a Neurogenic shock induced by a psychological trauma. The end result is the same. Nervous system dysfuction causes vessels to dilate. Big pipes, not enough fluid = low pressure.

no, you can't die from psychogenic shock, you could die from the potential sequalae however, mainly a heart attack, or from being injured while passing out.

 

One way to think about psychogenic vs the other types of shock is that it is the same physical response due to a psychological event rather than a physical insult to the person (infection = septic; neuro- & hypovolemic = physical injury). They body doesn't necessarily differentiate between them once the physical process gets going. In psychogenic shock the body's stress response overwhelms the person and their BP drops and they pass out due to lack of blood to the brain. My understanding is that in most healthy people the body realizes it overreacted and the readjusts to normal blood pressure and the person is pretty much fine. If they are frail physically/medically before the event, the body may not re-equilibrate so easily and return to a "normal" state.

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