Chapter 12: Shock

Chapter 12: Shock is a topic covered in the Harrison's Manual of Medicine.

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DEFINITION

Shock is a condition of severe impairment of tissue perfusion leading to cellular injury and dysfunction. Rapid recognition and treatment are essential to prevent irreversible organ damage and death. Common causes are listed in Table 12-1.

TABLE 12-1: Categories of Shock

Distributive shock (profound decrease in systemic vascular tone)

  •  Sepsis
  •  Pancreatitis
  •  Anaphylaxis
  •  Neurogenic (e.g., spinal cord injury)
  •  Endocrine-related (Addison’s disease, myxedema)

Cardiogenic shock

  •  Myopathic (acute MI, fulminant myocarditis)
  •  Mechanical (acute severe mitral regurgitation, acute severe aortic insufficiency [e.g., aortic dissection], severe aortic stenosis, acute VSD)
  •  Arrhythmic

Obstructive shock

  •  Pericardial tamponade
  •  Massive pulmonary embolism
  •  Tension pneumothorax
  • Hypovolemic shock
  •  Hemorrhage
  •  GI losses (vomiting, diarrhea)
  •  Burns
  •  Polyuria (diabetic ketoacidosis, diabetes insipidus)
Abbreviation: VSD, ventricular septal defect.

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DEFINITION

Shock is a condition of severe impairment of tissue perfusion leading to cellular injury and dysfunction. Rapid recognition and treatment are essential to prevent irreversible organ damage and death. Common causes are listed in Table 12-1.

TABLE 12-1: Categories of Shock

Distributive shock (profound decrease in systemic vascular tone)

  •  Sepsis
  •  Pancreatitis
  •  Anaphylaxis
  •  Neurogenic (e.g., spinal cord injury)
  •  Endocrine-related (Addison’s disease, myxedema)

Cardiogenic shock

  •  Myopathic (acute MI, fulminant myocarditis)
  •  Mechanical (acute severe mitral regurgitation, acute severe aortic insufficiency [e.g., aortic dissection], severe aortic stenosis, acute VSD)
  •  Arrhythmic

Obstructive shock

  •  Pericardial tamponade
  •  Massive pulmonary embolism
  •  Tension pneumothorax
  • Hypovolemic shock
  •  Hemorrhage
  •  GI losses (vomiting, diarrhea)
  •  Burns
  •  Polyuria (diabetic ketoacidosis, diabetes insipidus)
Abbreviation: VSD, ventricular septal defect.

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