Types of shock

Types of shock

Posted by AskNurseLinda on Feb 26, 2018 10:52 am

Everyone talks about shock or being in shock. When people startle us, we say we are in shock. This sudden surprise causes us to feel surprised, unsettled and startled, we may even get goosebumps. This type of shock soon resolves. There are typically no long term consequences. There are some other types of shock that are the body’s response to a startling surprise resulting in a response to bodily functions.

The body is always attempting to heal itself but before it can begin to do so, it needs to protect itself from immediate danger. The body will do this as a response to a sudden serious threat to life. It is called shock and there are several kinds. Spinal shock is a response to sudden injury to the spine. Individuals with slower progressing spinal injury from disease might not experience this type of shock as the body will gradually adapt to progressive minor changes that will eventually add up to a major result from disease. Septic shock is a response to rapidly progressing infection and hypervolemic shock is a response to too much fluid being added to your body so quickly that it cannot process the volume.

All shock requires emergency treatment. The sooner you receive care for shock, the better your outcomes will be as well as less complications.

Circulatory shock is the body’s direct response of protection for our most necessary body parts, the organs that keep our bodies going especially the brain, heart and kidneys. Other internal organs are protected as well.  In shock, blood is directed to the internal organs for survival. Blood pressure drops while the heart beat quickens. The extremities will become cool and ashen from lack of blood flow as the body protects internal organs by sending an increased blood flow to them. Tissue damage occurs both in the extremities and eventually in the internal organs. Circulatory shock can occur from any threat to the body including disease, accidents or infections.

Individuals with spinal cord injury from trauma or even other types of injury to the central nervous system will experience spinal shock. Spinal shock is a reaction to trauma to the spinal cord (not only from an accident but rarely can be as a result of disease or infection.)  The result is loss of motor function, sensation and reflexes below the level of injury.

The first phase is complete loss followed by some return of function over days, weeks or months. Some individuals have noted lack of return of reflexes over as much of a period of two years.  When reflexes return, they may be hyperactive resulting in spasms. Having a good relationship with your healthcare provider will be important to learning to care for this change in your condition. Keep a record of the time of the spasms, forcefulness and duration. Noting triggers will help your healthcare provider to be able to offer appropriate treatments.

The timing of the return of reflexes is variable among people. However, it is not unusual for the hyperactive reflexes to appear long after discharge from the rehabilitation facility. This dramatic change in response can make care much different from what was seen in the rehabilitation facility. Learning techniques and ways to control the hyperactive nerves can be a challenge for the individual at home.

Neurogenic shock is often confused with spinal shock. It can result from any threat to the central nervous system from trauma, disease or infection. This is a result of a disruption of the autonomic nervous system in which contraction of blood vessels to maintain blood pressure is reduced. The heart, which should increase pumping to compensate does not because of the effects of the autonomic system on the vegus nerve.
Septic shock results from an infection that gets out of control. All individuals have some sort of infection at one time or another. This can range from colds, urinary tract infections, surgical infections or even paper cuts. Rarely, but more often in immunocompromised individuals, these infections can run throughout the body quickly. This is septic shock or sepsis.
Symptoms of septic shock can vary but may include some or all of these:

S Shivering, fever or very cold feeling
E Extreme pain that is the worst EVER
P Pale or discolored skin
S Sleepy, difficult to wake up or confused
I “I feel like I might die” Impending doom
S Short of breath

There is more detail about sepsis and other issues for individuals with SCI on the Christopher & Dana Reeve Foundation Paralysis Resource Center's Wallet Cards.

Sepsis is extremely dangerous and needs to be treated within one hour for the best results. If you suspect sepsis, call 911 for immediate treatment.

Often, small infections recover on their own. More serious infections such as urinary tract infections will require antibiotic treatment. It is important to get treatment for infections when needed to stop them from mutating and multiplying. It is also important to avoid over use of antibiotics when they are not needed.

The overuse of antibiotics has led to the development of drug resistant bacteria. There are reports of otherwise healthy individuals using equipment or devices that someone else has used and left bacteria. The bacteria may not have harmed the first individual but is picked up by the second person and develops into sepsis. This can be use of therapeutic equipment as well as the shopping carts in the store.

One of the suspected reasons for this infection is the overuse of antibiotics making the bacteria particularly strong. Therefore, discuss antibiotic use with your healthcare professional. Follow their directions for taking an antibiotic, get treatment early so a lower level of antibiotic can be used and complete the full prescription even if you feel better. Stopping an antibiotic too early will not eliminate the bacteria but will allow it time to mutate into a stronger bacteria.

Another type of shock is a bit more unusual but extremely important to be aware if you have spinal cord injury from any cause. This is hypervolemic shock. It is caused from taking in too much fluid over short amount of time. This increase in the fluid in your blood volume most often results from too fast infusions of blood or IV fluid. However, taking in too much water or other fluids too quickly will give you some symptoms of hypervolemia.

Carefully monitoring fluid intake is especially important for individuals with spinal cord injury to keep the balance of taking in fluid with removal of urine. This protects the bladder from overstretching and keeps fluid from backing up into the kidneys leading to permanent damage. After SCI, individuals are taught to monitor their intake in relationship to their output to avoid these complications.

However, you can increase your fluids, slightly over time, to improve your general hydration. To do so, you can increase your fluid just by a quarter or half a measurement cup just one time a day. Over a few weeks’ time, you can increase again at a different time of day. If you keep increasing, eventually, you will need to increase your catheterization times however, stop increasing after adding a cup of fluid to your daily intake. Check with your healthcare provider to see if you are healthy enough to increase fluid intake. Everyone is different so a blanket statement of increasing fluids might not be for you especially if you have heart problems.

Sometimes people ‘over drink’. This can have serious complication especially if you have chronic health conditions such as SCI. Hopefully, you will not reach hypervolemic shock but you might feel over hydrated. These symptoms might include difficulty breathing, increased heat beats, a bounding pulse, increased blood pressure, nausea and vomiting. If the over hydration is severe you might experience changes in mental status, headache, seizures, rattles or crackles with breathing.

There is an opposite of hypervolemia and that is hypovolemia. This occurs with severe loss of fluid from a wound or a significantly draining pressure injury. You may have experienced hypovolemia at the time of your injury. Mostly, individuals will experience under hydration from lack of fluid intake or even sitting in a hot or humid environment. Symptoms of under hydration include increased breathing and pulse, cool skin, hypertension, lethargy, thirst, and lack of urine output. Loss of weight will occur over time. To avoid hypovolemia, position yourself in a cool or climate controlled environment. If you find yourself out side, be sure to hydrate appropriately and keep cool with wet cloths.

Any of the shock diagnoses are serious. All are extreme situations that you should not experience after your initial injury. Sometimes, we do things without thinking much about them such as drinking too much or ignoring signs and symptoms of an infection. Being aware of conditions that can affect health is key to maintaining your well-being.

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