Modern concept of etiopathogenesis and diagnosis of shock

Modern concept of shock

Abstract

Introduction: Shock is a life-threatening condition that occurs due to a mismatch in the supply and consumption of oxygen, which leads to cell and tissue hypoxia, resulting in cell death and dysfunction of vital organs. The effects of shock are reversible in the early stages, but delay in diagnosis and initiation of treatment can lead to irreversible changes, including multiorgan failure (MODS) and death. There are four main categories of shock: hypovolemic, distributive, cardiogenic, and obstructive. Etiology: Hypovolemic shock can occur due to hemorrhagic and non-hemorrhagic causes. Distributive shock is divided into septic, systemic inflammatory response syndrome (SIRS), anaphylactic, neurogenic and endocrine due to differences in etiopathogenesis. Cardiogenic shock occurs due to intracardiac causes, while obstructive shock occurs due to extracardiac causes. Pathogenesis: The pathogenesis of each type of shock is different depending on the etiology. Generally speaking, shock has three phases: compensated, cellular distress phase, and decompensated. When the shock progress into an irreversible phase, usually it ends with MODS and death. Clinical presentation: Symptoms may vary depending on the type and stage of shock. The most important changes that occur during this syndrome are at the level of hemodynamics, so the most common clinical signs indicating shock are hypotension, tachycardia, tachypnea, disturbed mental status, cold extremities, blue skin and oliguria. Diagnosis: The diagnosis of shock is based on history, clinical presentation, physical examination, vital parameters and biochemical analyses, SOFA criteria (sequential organ failure assessment score), SIRS criteria, acid-base status, blood count, hemodynamic monitoring, diuresis measurement, etc.