Question

1. Please differentiate between the 3 major causes of shock and describe the treatment for shock.
2. What is the difference between arterial and venous bleeding and what are the steps to control external bleeding?

200 WORDS MINIMUM

Answer 1

Shock:

Shock is a life threatening medical emergency which occurs as a result of decreased or insufficient circulating blood volume in the body.

Shock can be caused by number of contributing factors, some are listed below

• Uncontrolled bleeding
• Severe burns
• Spinal injury

Decreased blood pressure will lead to reduced flow of oxygen and nutrients to vital organs. Untreated may lead to severe complications and death.

Differentiation between 3 major causes of shock:

1. Hypovolemic shock: caused by insufficient blood volume in the body

• This may occur due to internal or external pathology such as rupture of organ or artery, accidents, injuries, wounds
• Severe vomiting, diarrhea, dehydration, severe burns

All the above can cause decreased circulatory blood volume and blood pressure and can lead to shock.

2. Cardiogenic shock: caused by failure of heart to pump blood in the body

• This may occur due to heart attack, congestive heart failure, cardiomyopathy, valvular disorders

These conditions can cause heart to fail and prevent it from functioning. Which will lead to decreased circulatory blood volume and can lead to shock.

3. Neurogenic shock: caused by injury or damage to the spine

• This may occur due to injury to spine and its nerves

Spine and its nerves control width of blood vessels and blood pressure. Injury to these can lead to vessel relaxation and expand themselves which will intern reduces blood pressure.

Treatment of Shock

First aid:

As it is a life threatening emergency, every minute and step of medical attention can save a life of person.

• Lie the patient down
• Keep the patient comfortable & warm
• Loosen all the clothing
• Raise legs to improve blood flow to the vital organs (Avoid if suspecting spinal injury)
• Manage if there is external bleeding by applying pressure directly on the bleeding site using clean cloth.
• Keep the bleeding limb above the body level
• Don’t provide anything to drink or eat
• Reassure and encourage to stay still

Treatment:

Treatment is purely based on type of shock and differs from one to another.

General treatment include

• Fluid resuscitation
• Fluid can be added with epinephrine, norepinephrine or dopamine to raise blood pressure and ensure vital organs are getting proper blood flow
• Tests to determine underlying cause of shock
• Identify underlying cause and treat
  

Hypovolemic shock:

• Minor shock can be treated with saline fluids
• Sever shock can be treated with blood transfusions

Cardiogenic shock:

• Patient may require surgical treatment for heart attack like cardiac catheterization to correct blocked artery
• Congestive heart failure require medications to increase heart function
• Heart transplant in server conditions

Neurogenic shock:

• Most commonly irreversible
• Immobilization
• Anti-inflammatory such corticosteroids

Difference between arterial and venous bleeding

Arterial bleeding:

• Bleeding originated from an artery
• Due to high oxygen blood will be bright red to yellowish in color
• Exit as spurt from wound
• Spurts out with heart beat
• Rapid and huge blood loss

Venous bleeding:

• Bleeding originated from vein
• Due to lack of oxygen blood will be blackish in color
• Steady flow from wound
• Can lead to sever blood loss if untreated

Steps to control external bleeding

• Identify site of bleeding
• Apply direct pressure over the bleeding site using clean cloth or pad
• If cloth soaks, do not remove it. Place or add more cloth or pad / remove and replace cloth or pad
• Maintain pressure until you get help
• Elevate injured limb if possible
• If direct pressure or elevation cannot be achieved, use pressure points to apply pressure and stop bleeding like place where pulse is felt (femoral artery / Carotid artery etc)
• Apply tourniquet if available
• Use clotting agents if available - external like powder or gel, internal like IV injections