Shock

Shock

1. Is a syndrome characterized by the inability of the heart or peripheral circulation to maintain adequate perfusion of vital organs.

   • It causes tissue hypoxia and cellular metabolic failure, either due to low blood flow or its irregular distribution.
   • PATHOPHYSIOLOGY
     • Alterations at the cellular level
       • Cellular hypoxia produces anaerobic metabolism, the result of which is increased lactic acid production and consequent metabolic acidosis, and indirectly, reduced cellular ATP production.
         • This depletion of ATP decreases energy-dependent cellular metabolic processes and results in cell membrane disruption accompanied by inflammation, thanks to the activation of leukocytes and macrophages.
           • During ischemia, ATP is not generated, although it is consumed, which leads to the generation and massive release of free radicals, which damage the membranes at the cellular level, and produce protein denaturation, and therefore apoptosis, leading to failure of the affected organ.
   • CLASSIFICATION
     • 1. Hypovolemic shock: hemorrhagic, non-hemorrhagic.
       • 2. Cardiogenic shock
         • 3. Obstructive shock
           • 4. Distributive shock: Septic shock, Anaphylactic shock,neurogenic shock:
             • 5. Combined shock

2. EPIDEMIOLOGY

   • Frequency of septic status in 70.3%, hypovolemic in 18.9%, cardiogenic in 10.8%, with a low incidence associated with the obstructive state. Becoming a public health problem before its high prevalence, mortality (46%).

3. CLINICAL MANIFESTATIONS

   • Hypotension, tachycardia, tachypnea, obtundation or abnormal mental status, cold, clammy extremities, mottled skin, oliguria, metabolic acidosis, and hyperlactatemia.
     • DIAGNOSIS
       • Is exclusively clinical, based on the observation of the symptoms and signs presented by the patient, as well as on its monitoring and the measurement of analytical parameters directly related to the process.