Shock is common in both primary care clinics and emergency rooms. Despite being reversible, the condition is lethal and can cause significant damage to an individual’s body. Therefore, understanding the pathopsychological and compensatory mechanism of shock is necessary in identifying, grouping shock, and enhancing faster and effective resuscitation on patients and the underlying condition (Standl et al., 2018). The paper focuses analyzing shock pathology, discussing assessment and management approaches of shock, and changes that should be provided by experts in managing both trauma shock and septic shock.
Pathophysiology of shock
Shock is a fatal condition that transpires within individuals when enough blood cannot be supplied in the body (Jozwiak, et al., 2020). With less blood flowing, the cells within the body and organs receive little to no oxygen and nutrients to function properly. In return most organs can be destroyed in the process, thus causing shock. Shock is characterized by perfusion of organs and tissues within the body. Insufficient oxygen in the cell’s metabolic causes the cells to change into anaerobic, thus resulting to the production of carbon dioxide. Chioncel (2020) admits that shock can be classified into three, namely, septic, hypovolemic, and obstructive shock type. As complex as it is, shock results to reduction in tissue perfusion causing less supply of oxygen, lactic acidosis, metabolic abnormalities, organ failure, and in worst cases damage and death (Convertino, & Schiller, 2017). Understanding the changes that occur due to pathophysiological changes and immediate diagnosis accompanied by effective monitoring, and therapy can minimize the chances of death caused by shock.
Usually when hypoperfusion occurs, the cells may start to coagulate or inflame as a response to shock. Activated by hypoxic vascular endothelium, the white blood cells in return produces dangerous chemicals and inflammation triggers. The triggers may align themselves on the cells’ surface, thus creating extra cytokines and excess production of nitrogen oxide. When this happens, toxins cause septic shocks which results to the compilation of cytokine (Closson, 2021).
Compensatory mechanism of shock
Cardiac filling and decrease in central venous pressure is usually caused by the minimization of blood volume during acute blood loss. This action causes a reduction in cardiac output as well as pressure in the arteries. Basically human body composes of compensatory mechanisms that aspire to return body functions into normalcy, that is, the arterial pressure and the volume of blood. The compensatory mechanism includes but not limited to reabsorption of tissue fluids, chemo reflector reflex, baroreceptor reflexes, activation of thirst mechanism, renal absorption of water and sodium, and circulation vasoconstrictors (Suresh, et al, 2018). Tissues within the body try to compensate for the reduced oxygen in the body by extracting a percentage of the already existing oxygen. Schlotman (2020) states that the body will automatically sense the reduction in blood, thus activating the sympathetic adrenergic system which in turn increases the heart rate and contractility. Cardiac outputs are also generated from less necessary organs to the mitochondria and brain.
2: Assessment and Management Approaches of Hypovolemic Shock Compared To Septic
Hypovolemic shock is a situation in which the liquid part of the blood, plasma, is very low (Taghavi, & Askari, 2018). This type of shock results from the decline in blood pressure that causes the inability of the heart to pump enough blood to important organs and cells, thus causing anaerobic metabolism. However, Pacagnella (2019) believes that septic shock is caused by bacteria that rapidity grows and infect the vital body cells. The bacteria cause toxins that kill important cells in the body. Hypovolemic shock is a lethal condition that is caused by loss of at least 15 percent of the blood due to conditions such like anemia or accident. Additionally, the condition can be caused by reduction of fluid in the body resulting from diarrhea or dehydration. As fluid of blood reduces or is limited in the body, the heart finds it difficult to pump enough blood in the body and increasing the production of carbon dioxide (Sembiring, 2020). Consequently, the body is disadvantages as vital organs and cells start to fail thus causing hypovolemic shock. On the other hand, septic shock is caused by bacterial infection in the blood that results to the production of toxins (Mahapatra, & Heffner, 2021). The toxins in return cause the body to react in form of inflammations. Toxins are usually produced when immune system tries to counteract with the bacteria, thus damaging vital cells and organs in the body (Berger, et al. 2017).
Development in Shock Assessment
Septic shock is fatal. Patients who have been diagnosed, treated and survived through septic shock usually risk living with lifetime conditions. Most health organizations including WHO have declared septic shock a health concern and are currently working on intervention measures to eradicate its severity. On the other hand, hypovolemic shock, as life-threatening as it is, has very few research discoveries. Health professionals have taken little steps in creating the shock’s awareness, especially after accidents.
Causes of Shock and Individuals at Risk
Fay et al., (2020) believes that sepsis can result from bacterial infection that may be acquired from home or in the clinical facility, especially when handling patients with the same condition. Septic shock often originates from lung infections like pneumonia, reproductive system infections, urinary tract infection, and digestive system infection (Hantoushzadeh, & Norooznezhad, 2020). When sepsis is not identified or diagnosed in time, then the patients risk having septic shock. Risk factors such as age and previous illnesses can put an individual at risk of contracting the shock. People including pregnant women, newborns, the elderly, and individuals with suppressed immune system as a result of kidney failure, HIV, liver cirrhosis, and cancer are at high risk of suffering from septic shock. Other factors such as injuries, open wounds, implanted medical devices are also predisposing factors. Hypovolemic shock is common especially in older individuals when compared to the youth. The condition results from reduced blood volume in the body.
Causes of Hypovolemic Shock and Septic Shock
|Septic shock||Hypovolemic shock|
|Bacterial infection||Excessive vaginal bleeding|
|Viral and fungal infections||Internal bleeding|
|Organ infections like reproductive track or digestive system infection||Excessive bleeding from injuries due to accidents|
|Loss of excessive body fluid through diarrhea, vomiting, or excessive sweating|
|Serious cuts that result to bleeding|
Diagnosis of Shock
The common means of diagnosing septic shock is through the application of blood culture test (Webb, et al., 2020). Further, doctors can run tests in urines and saliva to determine bacterial infections in the body. When the exact cause of infection is unclear, patients can undergo MRI, CT scan, and X-rays. Hypovolemic shock has no common early symptoms. Patients often undergo physical examination to determine blood pressure, and heartbeat rate (Llewellyn et al., 2020). It is necessary to determine the condition earlier to prevent further complications.
Comparison of Diagnoses
|Hypovolemic shock||Septic shock|
|Blood testing to check the severity of hypovolemic loss (Font, Thyagarajan, & Khanna, 2020).||Detection of brain malfunction symptoms.|
|Trauma ultra sound||Urine test (Titeca-Beauport, 2020) , saliva, and blood test|
|Less responsive during assessment||Wound secretion test|
|Ultrasound or CT scan to visualize body organs||X-ray, CT scan, MRI|
|Ultrasound of the heart||Low blood pressure at 100mm/Hg|
Management of Shock
Howell (2017) states that the sooner the diagnosis of sepsis the less likely the chances of septic shock. However, in the case of septic shock, clinical doctors often recommend a number of medical interventions. For instance, measures such as vasopressors, antibiotics, and corticosteroids can be used to treat the shock (Chang et al., 2020). Antibiotics are necessary in managing any kind of bacterial infection. Therefore, septic shock patients can be treated using direct injection of antibiotics into the blood. To reduce pressure, the patient can be provided with vasopressors. Vasopressors are helpful in managing the condition since they tighten blood vessels that control blood pressure (Shi et al., 2020). In case pressure cannot be regulated, Pirracchio et al., (2020) claim that patients are often given corticosteroids to manage pressure. Other measure includes administration of immune response drugs and insulin that help in stabilizing blood sugar (Rivas, & Nugent, 2021).
Hypovolemic shock is caused by reduction in blood or fluid volume, hence patients are provided with fluid or blood products when they visit the hospital (Hooper, & Armstrong, 2020). The most effective management strategy to hypovolemic shock condition is the provision of blood products and blood transfusion (Suresh et al., 2018). Additionally, medications like dopamine, norepinephrine, and epinephrine are effective in enhancing flow and blood circulation (Safiejko, 2020).
3. Changes in management of shock
Enhanced knowledge and skills among health professionals to manager sepsis at the early stages.
Strike for the implementation of molecular pathophysiology test to determine sepsis.
Encouraging the consumption of more fluid and blood products among members of the public.
Global recognition of the need to conduct more research on septic shock.
Creating awareness about the condition.
Encouraging the adoption of first aid kits and use among people to prevent the causes of hypovolemic shock.
WHO and CDC needs to recognize the shock as global hazard.
Provision of policies that minimize the chances of hypovolemic shock.
Shock is a fatal health hazard, especially among vulnerable communities. Therefore, understanding the pathopsychological aspects of both hypovolemic and septic shock is really necessary, especially when in the process of reducing or mitigating shock. Septic shock depends on bacterial, viral, or fungal infection to cause immune reaction through body inflammation. Hypovolemic shock however, is caused by high blood pressure. Indeed, identifying and determining the need of patients in dealing with the condition is vital in its reduction. Further, the world should recognize the existence of such conditions and provide remedies through conducting researches and studies to eliminate shock. Public awareness is also necessary in education the public about the implications of the condition.
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