Shock

Shock happens when there is insufficient circulation of oxygen in your body. The lack of oxygen causes your vital organs and tissues to shut down. It typically occurs when your blood pressure falls to a very low level, either from reduced cardiac output, or from reduced effective circulating blood volume. As your blood pressure falls, your brain and other organs do not get enough blood or oxygen to function, and they begin to fail. Shock can arise from a number of causes. It is a life-threatening medical emergency and must be treated early to avoid serious complications and even death.

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Signs and Symptoms

Common signs and symptoms of shock include:

• Low blood pressure
• Altered mental state, including reduced alertness and awareness, confusion, and sleepiness
• Cold, moist skin. Hands and feet may be blue or pale
• Weak or rapid pulse
• Rapid breathing and hyperventilation
• Decreased urine output

In septic shock (from overwhelming blood infection): shaking chills, rapid temperature increase, warm, flushed skin, and rapid pulse.

In shock related to heart problems: lung congestion, rapid pulse, heart murmur, and enlarged neck veins.

What Causes It?

Shock can have several causes. Doctors classify shock according to categories:

• Loss of fluid in the bloodstream (hypovolemic shock). This occurs after heavy bleeding from an injury or a condition, such as bleeding ulcers. Hypovolemic shock can also occur if your body loses too many fluids other than blood (such as losing water after severe diarrhea or vomiting, or losing plasma after serious burns).
• Blood vessels become too dilated (distributive shock). If the blood vessels expand too much, they are not able to keep blood circulating to all organs. Septic shock, which occurs when bacteria invade the bloodstream, and anaphylactic shock, which is a severe allergic reaction, are examples.
• Heart problems (cardiogenic shock). In this case, the heart does not pump enough blood through the body. It can be caused by a heart attack, abnormal heart rhythm, or damage to the heart from heart disease.

Who is Most At Risk?

The following conditions and characteristics increase the risk for shock:

• Serious injury and trauma
• Heart conditions, such as heart disease or heart attack
• Surgery
• Bacterial infection that has spread to the blood
• Bleeding
• Losing large volume of fluids from severe diarrhea or vomiting
• Excessive alcohol use
• Severe anemia
• Weakened immune system
• Allergic reaction to a drug, food, or environmental exposure
• Drug overdose
• Pregnancy

What to Expect at Your Provider's Office

Shock is an emergency and requires immediate conventional treatment. Your health care provider will diagnose shock based on your symptoms and any information about underlying disease or recent injury. Your provider will check blood pressure, assess mental status (memory, orientation, and alertness), measure urine output, and order blood tests to check heart, lung, and kidney function, and search for evidence of sepsis (blood infection). You may also undergo imaging tests and other procedures, such as x-ray, electrocardiography (ECG), echocardiography, and ultrasonography, to check the heart.

Treatment Options

Prevention

If you have heart disease or another condition that makes you susceptible to shock, you should seek treatment for that condition. If you have severe allergies, avoid substances that may trigger anaphylactic shock and carry self-injectable epinephrine to treat anaphylaxis.

Treatment Plan

The main goals of treatment are to maintain blood pressure and to make sure the person's vital organs get enough blood and oxygen. First aid for shock includes having the person lie on their back, raising their legs to help blood return to the heart, stopping any bleeding, covering them with a coat or blanket to ensure warmth, and performing cardiopulmonary resuscitation (CPR), if needed. Emergency medical staff will administer oxygen, and in the case of hypovolemic and septic shock, intravenous fluids.

Drug Therapies

Doctors may prescribe the following medications to treat shock:

• Drugs that increase pressure in the arteries and help the heart pump more blood, such as dopamine, dobutamine, and norepinephrine
• Medications to either dilate or constrict blood vessels (depending on the cause of shock)
• Antibiotics for septic shock, to combat wide-ranging infection
• Corticosteroids to reduce the incidence of vasopressor dependent septic shock
• Thrombolytic therapy (drugs that dissolve clots as they form) in the case of heart attack or pulmonary embolism

Complementary and Alternative Therapies

Shock is always life threatening and requires emergency conventional medical care. Some complementary and alternative therapies (CAM), however, may be used along with conventional treatment after a person's condition stabilizes, to help prevent shock. For instance, certain nutrients may help protect against the harmful effects of shock and improve the outcome of conventional treatment.

Nutrition and Supplements

Oxidative stress (damage to cells caused by the body's normal use of oxygen) may play a role in shock. Several studies show that antioxidants may protect against some types of shock, however, most of these studies have been done in animal. It is not known whether these supplements will also benefit humans.

You may address nutritional deficiencies with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium.
• Omega-3 fatty acids, such as fish oil (1 to 2 capsules or 1 to 2 tbsp. daily), for inflammation. Omega-3 fatty acids can have a blood-thinning effect, and can interact with other blood-thinning medications, such as warfarin (Coumadin) and aspirin.
• Vitamin C, 1 to 6 gm daily, as an antioxidant. You may use higher doses. If diarrhea develops, lower dosage.
• Coenzyme Q10 (CoQ10), 100 to 200 mg at bedtime, for antioxidant support. CoQ10 can have a blood-thinning effect, and can interact with other blood-thinning medications, such as warfarin (Coumadin) and aspirin.
• L-carnitine, 500 to 2000 mg daily for support of a healthy cardiovascular system. In a study of people with septic, cardiac, or traumatic shock acetyl-L-carnitine helped return heart rate and blood pressure to normal and boosted oxygen delivery throughout the body. L-carnitine may interact with some medications, including thyroid hormone, warfarin (Coumadin), and others. Speak with your physician.
• Resveratrol (from red wine), 50 to 200 mg daily, for antioxidant effects.

Herbs

Shock always requires emergency conventional medical treatment. It should never be treated with herbs. Talk to your doctor before taking any herbs to treat or prevent shock.

Homeopathy

No scientific studies have evaluated homeopathic remedies for the treatment of shock, however, homeopathic doctors often use the remedy, aconite, for emergency conditions. In homeopathic remedies, aconite is highly diluted, and only a trace amount of the herb is present, so it is not toxic in a homeopathic formulation.

Prognosis/Possible Complications

If someone suffering from shock receives immediate treatment, the prognosis is good. Immediate treatment for anaphylactic shock, for example, usually results in complete recovery. But any case of shock is life threatening, regardless of its cause, particularly in the elderly. Shock often causes organ damage (including the kidneys, brain, and liver), cardiac arrest, and respiratory failure. More than 90% of young, otherwise healthy people with hypovolemic shock survive with appropriate treatment. In comparison, septic shock, or shock associated with heart problems, can have substantially worse mortality rates, even with optimal care.

Following Up

If you are suffering from shock, you will likely be admitted to intensive care. Following treatment, your health care provider will carefully monitor your condition, including temperature, blood pressure, heart function, urine flow, and blood chemistry.

Supporting Research

Anderson ML, Peterson ED, Peng SA, et al. Differences in the profile, treatment, and prognosis of patients with cardiogenic shock by myocardial infarction classification: A report from NCDR. Circ Cardiovasec Qual Outcomes. 2013;6(6):708-15.

Bope and Kellerman: Conn's Current Therapy 2012. 1st ed. Philadelphia, PA: Elsevier Saunders; 2011.

De la Fuente M, Victor VM. Anti-oxidants as modulators of immune function. Immunol Cell Biol. 2000;78(1):49-54.

Groeneveld AB, Molenaar N, Beishuizen B. Should we abandon corticosteroids during septic shock? No. Curr Opin Crit Care. 2008;14(4):384-9.

Kethireddy S, Light RB, Mirzanejad Y, et al. Mycobacterium tuberculosis septic shock. Chest. 2013;144(2):474-82.

Kliegman: Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011.

Kumar: Robbins and Cotran Pathologic Basis of Disease, Professional Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2009.

Larsen GY, Mecham N, Greenberg R. An emergency department septic shock protocol and care guideline for children initiated at triage. Pediatrics. 2011;127(6):e1585-92.

Li YL, Chan CP, Sin KK, et al. Validating a pragmatic definition of shock in adult patients presenting to the ED. Am J Emerg Med. 2014;32(11):1345-50.

Lodha R, Arun S, Vivekanandhan S, Kohli U, Kabra SK. Myocardial cell injury is common in children with septic shock. Acta Paediatr. 2009;98(3):478-81.

Puskarich MA, Trzeciak S, Shapiro NI, Arnold RC, Horton JM, Studnek JR, Kline JA, Jones AE. Association between timing of antibiotic administration and mortality from septic shock in patients treated with a quantitative resuscitation protocol. Critical Care Med. 2011;39(9):2066-71.

Sligl WI, Milner DA, Sundar S, Mphatswe W, Majumdar SR. Safety and efficacy of corticosteroids for the treatment of septic shock: A systematic review and meta-analysis. Clin Infect Dis. 2009;49(1):93-101.

Strehlow M. Early Identification of Shock in Critically Ill Patients. Emergency Medicine Clinics of North America . 2010;28(1).

Venkatesh AK, Avula U, Bartimus H, Reif J, Schmidt MJ, Powell ES. Time to antibiotics for septic shock: evaluating a proposed performance measure. Am J Emerg Med. 2013;31(4):680-3.

Victor VV, Guayerbas N, Puerto M, Medina S, De la Fuente M. Ascorbic acid modulates in vitro the function of macrophages from mice with endotoxic shock. Immunopharmacology. 2000;46(1):89-101.

Wong HR, Cvijanovich NZ, Allen GL, et al. Corticosteroids are associated with repression of adaptive immunity gene programs in pediatric septic shock. Am J Respir Crit Care Med. 2014;189(8):940-6.

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Review Date: 3/24/2015  

Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare.

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