written by Gloria Poole,RN, artist of Missouri
Shock is a medical emergency because it is life-threatening. In the US, it causes thousands of deaths and unknown numbers of injuries that occurred secondary to shock. It is essential that it is recognized early on and appropriately treated to save the person's life. It is a frequent occurrence with trauma.
A. There are 3 classifications of shock:
I. hypovolemic [low volume of blood and plasma circulating in blood stream]:
II. Cardiogenic ; secondary to severely damaged cardiac muscle ;
III. Distributive: is also called vasogenic shock occurs when blood vessels dilate but the circulating volume of the blood does not increase.
B. Causes of shock
Shock is caused by :
1. bleeding [hemorrhage] ; is hypovolemic;
2. burns when plasma shifts massive fluid volumes into interstitial spaces and out of the blood stream; hypovolemic.
3. failure of the left ventricle of the heart to pump adequately [cardiogenic shock] which could be caused by :
a) disease of heart
b) mechanical obstruction of blood flow caused by MI, [heart attack]
c) valvular insufficiency caused by disease or trauma
d) cardiac arrhythmia or dysrhythmias [no heart beat, or irregular, erratic heartbeat]
e) cardiac tamponade is when fluid collects in the pericardial sac around heart & prevents normal heart compressions
f) pulmonary embolus is a blood clot that travels to the lungs from the deep veins in the legs, or originates in the lungs
g) myocardial aneurysms
h) rupture of a valvular papillary muscle
i) ventricular rupture [the left ventricle ruptures]
j) aortic stenosis
k) mitral regurgitation
l) cardiac dysrythmias
m) infections and inflammation around the heart of the pericardium or endocardium
n) pulmonary hypertension
o) toxic drugs
4. Anaphylaxis is when the person is so allergic to something it causes cardiac arrest
5. Neurogenic shock is caused by :
a) spinal cord injury especially cervical spine injuries
b) spinal anesthesia
c) severe vasovagal reactions secondary to pain or trauma
6. Septic shock which is caused by bacteria that has become so pervasive that it has infected the blood supply, and all organs and tissues.
C. The etiology of shock
Shock however it is classified, is because not enough blood gets to the vital organs of the brain, heart and kidneys for any of those reasons above. The human body compensates for that condition by a series of changes orchestrated by the brain until it cannot compensate anymore and then shock occurs. Think of shock as an "early warning system " that life threatening events are taking place within that person. The word hypovolemic consists of prefix hypo- which is low or below normal and volume so it means volume is too low. To make an analogy most people could understand it is as if an engine has too little oil in it and grinds to halt. That is the most common type of shock.
The word cardiogenic consists of cardio- [prefix] for heart and -genic meaning origin. It originates with the heart itself. The clinical definition of that is :" decreased cardiac output [pumping of blood to the body] and evidence of tissue hypoxia [not enough oxygen to the cells] in the presence of an adequate amount of blood. The criteria for cardiogenic shock are sustained systolic blood pressure lower than 90 mm/Hg for at least 30 minutes and a reduced cardia index of <2.2liters/min/m2 in the presence of elevated pulmonary capillary occlusion of < 15mm Hg . Other manifestations are urine output of less than 30 cc /hr, cool extremities and altered mentation [ability to think clearly] . Cardiogenic shock usual occurs after a myocardial infarction [MI] when 40% or more of the heart is damaged, and it has a rate of death because of it, of 80%. Cardiogenic shock is treated by treating the underlying cardiac problem and simultaneously treating the shock. IF fluids are administered but a much slower rate in order not to overwork the heart. and of course, oxygen is given and inotropic agents and vasodilators and sometimes an intraaortic balloon pump is surgically implemented to restore circulating volume.
For septic shock, the mortality rate rises from 15% for sepsis to 40-60% deaths if shock is present.
The way the body compensates for shock, whatever the cause, is to increase the respirations, increase the heart rate, and shunt blood to the vital organs. If shock is not reversed quickly, then the kidneys suffer irreparable damage and urine production stops. Also, the heart rate may get so fast it causes tachycardia which is another strain on the body as the heart beats so fast it does not fill adequately or pump adequately and beings to fail. When that happens, the blood pressure falls and the patient becomes confused as his brain is not getting enough blood or enough oxygen.
For hypovolemic shock, the treatment is an intravenous replacement of Crystalloid at 3 ml/ 1ml of blood loss if hypovolemic, and if more than 2000 cc of blood has been lost then blood replacement also.
Anaphylactic shock is caused by a severe allergic reaction that causes massive vasodilation of the blood vessels, and fast drop in bloods pressure to very low levels. It may begin with hives, laryngeal edema [swelling of throat] and bronchial constriction [person cannot get air into lungs]. Without rapid response a person with anaphylactic shock will die from cardiovascular collapse and respiratory failure. Epinephrine injected is the reversal of anaphylactic shock. The "Epi_Pen" is a commercial ready prepared syringe filled with epinephrine that some very allergic people are advised by their medical doctors to keep on them. Also, those patients should wear an allergy bracelet or identifier of some sort for quick alert to all.
Shock affects the acid-base balance and EVERY system in the human body. Getting adequate oxygen into the body and getting it sent to all organs is crucial for survival. Shock produces prolonged lack of adequate oxygen and the organs suffer. Hypoxia and anoxia can only be tolerated for a short time. As those conditions continue, [if not reversed] the chances of recovery go down. When shock become irreversible with oxygen or IV fluids, acute respiratory disease syndrome [ARDS] occurs in many cases leading to complete respiratory failure. Other conditions which cause respiratory failure are aspiration of vomit, and loss of the brain's control over respirations. When oxygen is not present, adenosine triphosphate is produced through anaerobic metabolism, which produces lactic acid, which causes intracellular acidity which causes cellular damage, and substrates of the adenylic acid system which depress the heart function. The body's chemoreceptors sense the the decreased pH and they try to compensate by increasing the rate and depth of the breathing [respirations]. they attempt to "blow off" or exhale the increased CO2 to compensate for the metabolic acidosis. this results in respiratory alkalosis. Because lactic acid is not exhaled, it accumulates in tissue fluids which become increasingly acidic. Metabolic acids is eventually produced, which lowers the blood pH and bicarbonate levels in the blood. Pyruvate, lactate, phosphate and sulfate all increase. Unless this is reversed and circulation restored, the acidotic reaction kills the cells. As shock progresses, the heart deteriorates, and that is one of the major causes of death in shock.
There is no way to cover fully the topic of shock in this effort to educate people without any medical training. I am simply trying to give you the basics in understanding what shock is, what it causes and how it is treated, so hopefully you would recognize it if ever necessary. What is critical for you or any first responder to know is that SHOCK IS A LIFE-THREATENING EMERGENCY. Even sometimes when the patient survives, his extremities won't survive because the body in trying to save itself, shunted blood from the arms and legs to the vital organs to keep the person alive. When that happens for a long enough time, cellular death of the arms and legs occurs and the person would have to have amputations to survive and to prevent gangrene.
I have worked with patients in the shock-trauma unit and so I know much about this topic but I was also referencing a medical textbook of Medical-Surgical nursing, volume II, chapter 81, eight edition, written by Joyce M Black and Jane Hokanson Hawks.
A special thank you to my viewers/ readers in the U S and France.
You can follow me on twitter at : @ProlifeNurse; @personhood1; @gloriapoole; @gloria_poole; @tweetie0817; and at @Tartan_Bliss, which are my twitter accounts that are written entirely by me Gloria.
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You can read more on the prolife and personhood causes on these blogs of mine:
http://gloriapoole.livejournal.com [scroll to the list of medical references]
http://gloriapoole-UK.livejournal.com [scroll to articles]
https://sites.google.com/site/optimumhealthisachievable/ ; or at :
I referred to the textbook Medical-Surgical Nursing ,Eight Edition Vol I, written by Joyce M. Black and Jane Hokanson Hawks. chapter five, pages 69 and 70, but I am also a Registered Nurse who has had my license for years, and I worked in a hospital operating room and an ambulatory surgery center, and I wrote the Infection Policy Manual for the Ambulatory Surgery Center I worked in [it had to be approved by board of medical doctors and it was], and I worked on med-surg and shock-trauma units and Emergency departments in my career. I have a Registered Nurse license in the state of Missouri.
About me Gloria Poole, RN, artist, blogger, writer, author, photographer, tweeter:
This is my selfie of me Gloria Poole in spring 2014 sitting on my sofa in Missouri; but it is my most recent selfie. I am still putting my hair in a lop-sided pony tail however and look the same.
Symbols and photos that represent me Ms Gloria Poole, RN, artist of Missouri and Georgia:
This is one of my Christian crosses that I wear sometimes, and my hand as it looks this year. I am posting it here to remind all that I am a believer in THE LIVING LORD JESUS who is THE MESSIAH as foretold by the Old Testament. You can read more about JESUS and how to be born again on this blog of mine:
This is my personal logo that I made to add to blogs. I add it intermittently to blogs.
This is the seal of the Georgia Baptist College of Nursing where I graduated nursing school years ago. I am a Registered Nurse licensed in Missouri but before that in other states; but for most of my life, my license was in state of Georgia, where I was born and grew up and was educated.
For the record, I never worked with or for my 2nd exhusband [with initials DBP in Colorado who is a massage man] in any capacity and he never worked with or for me in any capacity. It is necessary to write that because he has NO authority to sign my name to anything nor to hijack any account of mine, nor to represent himself as any sort of agent of mine. He injured me several times,and he tried to kill me four times and said he intended to annihilate me from life and the web. DBP by any name is not a business partner of mine and never was, nor is he a courier, nor associate, nor employee,nor assistant ,nor boss, nor supervisor,nor agent, nor "co-worker" of mine AND NEVER WAS. This documentation is necessary for law enforcement and the public to know that if/when male DBP tries to intercept messages, photos or phone calls to me he is stalking me and he is violating a mandatory protection order issued by a Magistrate to prevent DBP from coming near me or my dwelling or any place that he knows I would be such as my family of origin home etc. I removed the Pappas name from my name at the time of final divorce decree in Oct 2007 by order of Judge who signed final divorce decree from male DBP; and I resumed my born with name including my surname of Poole. I MOVED to Missouri on Oct 31, 2009 and into my own apt on Nov 3, 2009. I got reciprocity of my Registered Nurse license in Missouri from my state of origin Georgia.
LEGAL NOTICE OF COPYRIGHT INFRINGEMENT :
For the record: this blog https://gloriapoole.blogspot.com AND ALL BLOGS THAT I CREATE belong ONLY to me Gloria Poole,RN,artist of /in Missouri. The ID thieves named "iconosquare" are criminal hackers who tried to hijack my real name, my content, my identity and my blogs & they should be arrested for fraud, ID theft, and cybercrime. I do not have any affiliation of any sort with the group iconosquare and do not know who they are but Google alerted me that they are using my real name of Gloria Poole, and putting what may be content they stole from me behind a black screen that requires a log in and registration. I do not put my content behind black screens ever, nor do I require registration to view my content. Also, any content I create can be viewed by anyone of any age in any country. If iconosquare is putting immoral stuff they made on a website and attaching my real name to it, then are guilty of slander and defamement. This is a public notice intended for law enforcement, the general public so they are not deceived, and for banks and my isp account and my telephone carriers so they are not deceived. I do not authorize and never authorized any person or group named "iconosquare" to use my name or any content I created, or any photo, or any thing of mine including bank cards, confidential info about me, [to buy domains or anything] and I denounce them now. I do not pay my bills online and I do not have Paypal accounts so those frauds [attempts to use my info] should be stopped immediately. And I have never authorized any person at any time to act as an agent on my behalf for any reason.
Second notice of copyright infringement and identity theft: Google alerted me that a company that is totally unknown to me stole a graphics file of mine that I made and in which I signed my real name using digital ink and a mouse on a computer software program and I included my Registered Nurse status [licensed in Missouri] and my status as artist and photographer from off a bluff of mine; and that those ID thieves posted that file [or copy of it--I have the original file] to a site they made for p-o-r-n. ALL art that I create is moral and decent and may be viewed by anyone of any age in any country. It is for general audiences. The name of the company that stole my signature in digital ink to post to their site as a way of trying to ruin me is pix-collection dot com. I have notified the @FBI, @Google and banks and the public that I do not know the owners of pix-collection dot com as far as I know but I suspect my 2nd exhusband in Colorado has something to do with it since he has been trying to annihilate me from life and the web since 2005. I have NOT and do NOT authorize pix-collection dot com to use my name, nor my signature via any method, nor any file of mine, nor any photo or art work I ever made at any time in my life, nor do I authorize them to withdraw money from any account of mine, nor use my physical address, nor my telephone numbers, nor any account of mine anywhere. I am NOT associated with them in any way. pix-collection dot com are IDENTITY THIEVES, AND CYBER-CRIMINALS WHO STOLE INTELLECTUAL PROPERTY THAT INCLUDES MY SIGNATURE AND REAL NAME OF GLORIA POOLE, AND MY STATUS AS REGISTERED PROFESSIONAL NURSE LICENSED IN MISSOURI, and I am certain it was for malicious reasons considering that I have never at any time in my life produced nor promoted p-o-r-n, and would not. I am a CHRISTIAN, Bible-believing single-again, white woman and I promote the gospel not evil.
Third notice of copyright infringement on 30th Oct 2015: I was alerted by Google that a company named "MarkMonitor Inc." bought a domain with my real name of Gloria Poole, in it and they ILLEGALLY forwarded their domain of gloriapoole-paintings.blogspot.com dot BE to my blog of https://gloriapoole-paintings.blogspot.com. I alerted the FBI to ID theft of my name and content and also ICANN. Also, for the record, I am NOT on Facebook nor Pinterest and NEVER was, because they make their users their content and try to take copyrights, and sell their users' information, and track their users on the web. The cyber-criminals that tried to hijack my content via Facebook and Pinterest are common criminals that are identity thieves and they should be in prison.
Copyright notice:I, Gloria Poole, own all rights to all content on this blog. Usually I sign the art I create as simply Gloria since that is my first name, that I was born with; but on pencil and or ink drawings I sometimes also sign my born with surname of Poole which is my legal name again because I removed the Pappas name from my name at time of final divorce decree in Oct 2007 from male DBP, and I resumed my full maiden name by Court order at the same time. I am also known on the web and in real life as Gloria; Gloria Poole; Gloria J Poole; Gloria Poole, RN, artist; and on the web as : gloriapoole; gloria-poole; gloria.poole; Ms Gloria Poole; gloriapoole.RN; gloriapoole_RN; gloriapooleRN at yahoo; gloria0817; gpoole817; artist-gloriapoole; gloriapoole-paintings; artist-gloria; Poole,Gloria; gloriapoole1749; and other variations of my real, born with, and legal name of Gloria Poole. For the record, I am a white, single-again, twice divorced, Southern Baptist, born again, Christian, woman and the mother of only two children who are grown daughters who are named Jennifer and Leigh. I am also a prolife activist, blogger, artist in all mediums; photographer for my own purposes, Registered Nurse with a license in Missouri but before that for most of my life in the state of Georgia, U.S. citizen born in the state of Georgia; University of Georgia alum, Georgia Baptist College of Nursing alum, writer, illustrator, author, personhood promoter. This blog may not be downloaded, nor copied individually or collectively as a whole; nor have domains forwarded to it that do not belong to me, nor may the photos or art on it be reproduced or saved to disk by anyone . Repeat for emphasis: I create all content on this blog and I, Gloria Poole, own all rights to this blog collectively and individually as single posts. All telephones listed on this account and any account of mine on the web belong to me personally and are in my apartment in Missouri or in my possession at all times. Some of my numbers are wired, landline telephones and some are mobile phones. This blog and all blogs that I create and that contain my words I wrote and or art I made and signed and or photos that I photographed belong exclusively to me Gloria Poole, of Missouri and Georgia. Copyright. Gloria Poole / Gloria / gloriapoole /gloria-poole /gloria.poole/ Ms Gloria Poole/ Poole Gloria / G-L-O-R-I-A / gloriapoole1749 /gloria0817 /gpoole817 / gloriapooleRN at yahoo / gloriapoole.RN / artist-gloriapoole /Gloria Poole,RN,artist /cartooning-by-gloriapoole / photo-by-gloriapoole, and other variations of my real name with or without my professional status as Registered Nurse and with or without numbers after my name, at my own private apt in Missouri which is not shared with anyone and neither is my equipment nor phones shared with anyone, and neither is my isp account shared with anyone which means no one is authorized to log into any account of mine anywhere but me. /signed/ Gloria Poole, RN, artist; at my apt in Missouri on 9th Nov 2015 at 3:45pm. Gloria Poole / Gloria / gloriapoole / [Ms ] Gloria Poole,RN,artist of / in Missouri, USA .