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Circulatory shock - causes, first aid and treatment

Circulatory shock - causes, first aid and treatment


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What are the symptoms of cardiovascular shock and what immediate measures are important

The cardiovascular shock describes an absolute state of emergency of the body's cardiovascular system. Since it can lead to complete organ failure without suitable countermeasures, the circulatory shock always constitutes a medical emergency that must be treated immediately. This guide provides details on the subject.

Definition

As a circulatory shock, medicine describes an absolute state of emergency of the body, in which the body tries to compensate for a life-threatening oxygen deficit in the organs. In the first step, the distant (peripheral) capillaries are narrowed in order to stabilize the blood pressure in the middle of the body, i.e. the location of vital organs. However, this mechanism means that the peripheral tissue is less supplied with blood and thus suffers from an increasing supply of oxygen (hypoxia).

Important metabolic end products (especially lactate) can no longer be transported away due to the low supply and are deposited. The condition that occurs in this way is also referred to as overacidification (metabolic acidosis) and in the further course leads to an increased leakage of fluid into the tissue, which results in a further drop in blood pressure. The oxygen supply to the body is deteriorating, while the carbon dioxide content of the blood increases more and more.

The overacidification in the periphery, which arises in the course of the circulatory shock, can also cause blood congestion in the small capillaries, which can lead to dangerous vascular occlusions (microthrombi). In addition, the functional disorders in the body household provoke an increased consumption of coagulation factors, which are required for blood clotting. This results in an increased tendency to bleed.

Once the body is in this shock spiral, it can no longer free itself from it without medical intervention and there is a multi-organ failure that ultimately leads to the death of those affected. For this reason, it is essential for survival to recognize and counteract the signs of cardiovascular shock as early as possible.

Causes of circulatory shock

When it comes to the causes of circulatory shock, a distinction must first be made between three main forms of shock:

  • cardiogenic shock - The cardiovascular shock is triggered by a malfunction of the heart
  • hypovolemic shock - The shock is caused by a reduced volume of fluid in the body
  • distributive shock - The circulatory shock is based on an unfavorable distribution of the liquid volume

Such exceptional situations can arise in the body on the one hand due to numerous accident scenarios, in particular in the area of ​​the brain, which serves as a control center for all cardiovascular functions. On the other hand, certain underlying diseases cannot be ruled out as the cause of the circulatory shock. This applies in particular to organ malfunctions due to illness.

Cardiogenic shock

As the name suggests, cardiogenic shock is triggered by an internal malfunction that results in a decrease in the pumping power of the heart. As a result, the heart muscle can no longer pump the usual amount of blood volume into the body. As a result, the body's own organs and tissue structures are no longer adequately supplied with blood and are only poorly supplied with oxygen and nutrients.

A corresponding reduction in the heart pumping power can be due to numerous damage to the heart. For example:

  • Congenital heart valve defects
  • Heart failure (heart failure)
  • Irregular heartbeat
  • Pericardial effusion (fluid accumulation in the area of ​​the pericardium)
  • Narrowing of the heart (e.g. due to coronary artery disease)
  • Inflammation of the heart (e.g. endocarditis or myocarditis)

All of these diseases have a huge impact on cardiac pumping performance and lead to a massive lack of oxygen in the final stages of the disease due to insufficient blood flow. In the worst case, cardiovascular shock is preceded by a heart attack.

In addition to heart-related diseases, lung complaints should not be underestimated as the cause of cardiogenic shock. Heart problems are very often restricted by any breathing problems. This is particularly common Pneumothorax involved. Air collects in the pleural space between the lungs and the heart, which can cause extreme functional restrictions of the heart in the long term. Also Pulmonary edema and Pulmonary embolism are able to trigger cardiogenic shock in the advanced stage or in the extreme course of the disease. In the worst case, the state of shock indicates one Lung tumor there.

Hypovolemic shock

Hypovolemic shock is also known as a lack of volume shock and is based on an acute, increased loss of fluid. With good constitution, an adult can survive about 20% fluid loss (corresponds to about one liter) without damage, because the body can compensate for this fluid loss itself. However, if the fluid loss is above this, a shock situation results. The hypovolemic shock leads particularly quickly to threatening conditions in childhood.

Typical health complaints that can cause such a shock due to extreme loss of fluid are, for example, heavy internal and external bleeding, as is especially the case with severe Accidental injuries occur. If, for example, a massive brain hemorrhage occurs in the course of a car accident, a hypovolemic shock is a very feared complication.

Also bleeding from the bowel caused by an accident, for example after The effects of violence with serious injury objects with sharp edges in the area of ​​the kidneys, liver or intestines cause a shock-causing loss of fluid. The situation is similar with large-scale burns. Experience has shown that the resulting wound surfaces wet massively and thus withdraw large amounts of fluid from the body. Furthermore, extreme diarrhea (e.g. with gastrointestinal flu), persistent vomiting and dehydration as the cause of the hypovolemic shock cannot be ruled out.

Distributive shock

In contrast to hypovolemic shock, distributive shock does not result from a loss of fluid, but from an unfavorable distribution of the volume of fluid in the body. The relative amount of fluid is therefore sufficient, but certain processes in the body mean that the body fluids are no longer distributed in the sense of a natural balance. Corresponding processes significantly provoke septic and anaphylactic shock.

Septic shock

As a result of a locally limited or whole body infection, messenger substances are released after the antigen-antibody reaction. The exact course of a septic shock has not yet been finally researched. However, it is known that the messenger substances trigger the following reactions:

  • Edema formation with a corresponding drop in blood pressure
  • accelerated heart and respiratory rate
  • Increase in body temperature
  • Increase in white blood cells (leukocytes) in the blood

It is suspected that the body is severely weakened by infection-related inflammations in the event of a septic shock and is consequently no longer able to fight the inflammation at the scene. The body therefore releases more and more inflammatory messengers, which then flood the bloodstream. A septic shock can develop, for example, in the context of numerous infectious and inflammatory diseases. In the area of ​​the internal organs, this applies above all

  • Lung infection,
  • Gallbladder inflammation,
  • Peritonitis
  • and pancreatitis

as particularly risky. Serious infections such as cholera or pulmonary embolism are rarely responsible. Beyond that too Operational complications conceivable as a trigger of septic shock. Similar to hypovolemic shock, there are also Burns considered as the cause.

Anaphylactic shock

In addition to septic shock, the same applies anaphylactic shock as a frequent trigger of a distributive shock spiral. It occurs as part of an allergy and is consequently caused by an excessive immune response by the body to allergens. The immune system classifies the relevant allergens as potentially dangerous and releases excessive amounts of messenger substances (especially histamine), which in turn trigger excessive immune reactions. Among other things, this leads to a dilation of the vessels and the resulting drop in blood pressure. A narrowing of the bronchi and shortness of breath triggered by them are also typical of anaphylactic shock. The body usually reacts to this by increasing the heart rate in order to compensate for the drop in blood pressure and shortness of breath. If this condition remains untreated, a circulatory shock is inevitable.

Symptoms of circulatory shock

The alarming symptoms of circulatory shock are mostly pretty clear. Above all, a pale face, a sharp drop in body temperature and cold sweat indicate the dangerous state of shock. Overall, the following complaints can occur:

  • Facial pallor,
  • cold skin,
  • Chills / freezing,
  • Cold sweat,
  • inner unrest,
  • extreme circulatory problems up to breakdown,
  • Confusion and fatigue,
  • Impaired consciousness,
  • nausea
  • and vomiting.

Important: Circulatory shock is always an emergency. In addition, persistent lack of oxygen can cause tissue necrosis and putrefaction in the body if the shock is not treated in time. If there are any signs, please call an emergency doctor immediately!

The circulatory shock is usually diagnosed by the emergency doctor through mere eye diagnosis in combination with a blood pressure and pulse measurement. If the affected person is still able to be heard when the emergency doctor arrives, the emergency personnel will usually ask for additional information regarding possible health problems and symptoms. After the corresponding emergency measures have been carried out, in-patient monitoring is usually carried out using an EKG. The duration of the inpatient stay depends on the underlying cause, for the determination of which also imaging measures and laboratory tests, such as blood tests, are used.

First aid and therapy of circulatory shock

Even though critical emergency procedures in the event of circulatory shock must be carried out by professional paramedics, there are some first aid measures that private individuals can use to stabilize the patient:

Is the cause cardiogenic, you bring the person concerned into a quiet position with an elevated upper body. Often those affected take this attitude independently. In addition, tight clothing can be opened and fresh air can be provided.

Is the cause hypovolemic, you are brought into shock with a flat upper body and slightly raised legs. In addition, obviously bleeding wounds should be covered sterile and provided with a pressure bandage.

At a anaphylactic shock there is not much you can do yourself, except to keep calm and calm those affected. If those affected have their acute medication with them, they should be helped if necessary.

Have affected people already the stage of unconsciousness reached, regardless of the suspected cause, they must always be placed in a stable lateral position.

Drug therapy for circulatory shock

Drug therapy depends entirely on the cause of the circulatory shock. In cardiogenic shock, the primary focus is on the causal treatment of the causative disease. In addition, an adequate supply of oxygen to the body is restored via external supply (oxygen goggles, oxygen mask, respirator) and those affected are soothed or even sedated by appropriate medication.

Acute therapy for hypovolemic shock consists of compensating for the loss of fluid from the outside. Most often this happens through infusion solutions applied through the vein. Furthermore, the cause of the hypovolaemia is clarified and the remedial measures are initiated, for example by giving antibiotics or adequate wound care. Antibiotic medication is also important in septic shock. Cardiovascular parameters and fever are also treated symptomatically.

Anaphylactic shock is treated with antihistamines and cortisone-containing inhalants or infusion solutions. In addition, the oxygen supply is guaranteed via external routes.

Surgical treatments

Operative treatments for circulatory shock can be considered for various causes. For example, with internal and external bleeding, which then necessitates surgical closure of the wound. The same applies to severe burns. In the event of a heart attack, a stenting in the coronary arteries may be necessary. Stents are artificial elements for vasodilation, which improves blood circulation and thus the oxygen supply to the body.

If there is fluid accumulation or a pneumothorax, the surgical measures most likely consist of draining the fluid or air using drainage. Furthermore, organ resections or organ transplants are conceivable if the corresponding organs threaten to fail. An example of this would be end-stage gallbladder infection.

Of course, operations with a circulatory shock always require a thorough risk-benefit analysis, as they are always an additional burden for the body, which is already under massive stress. Often, especially with cardiogenic causes, they are the only salvation for the patient.

Naturopathy for circulatory shock

If the affected person is fully conscious, awake, responsive and stable during a circulatory shock, the Rescue Essences from the Bach Flower Assortment can be used with their consent. This combination of 5 different Bach flower essences, available as drops or globules, can support the body in acute stressful situations and, for example, alleviate the panic and anxiety that occurs in cardiovascular shock. However, it should be noted that Rescue drops may only be used in a supportive manner and in no way replace medical treatment and care by specialist medical staff and paramedics.

Circulatory shock diseases

: Heart valve defects, heart failure, cardiac arrhythmia, pericardial effusion, coronary heart disease, endocarditis, myocarditis. Pneumothorax, pulmonary edema, pulmonary embolism, lung tumor, accident injuries, diarrhea, vomiting, dehydration, sepsis, anaphylactic shock, infectious diseases. (ma)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Swell:

  • Levi D. Procter: Circulatory Shock, MSD Manual, (accessed 8/28/2019), MSD
  • K. Werdan et al .: Heart attack-related cardiogenic shock, diagnosis, monitoring and therapy, guideline of the German Society for Cardiology - Cardiovascular Research, (accessed 28.08.2019), AWMF
  • Kurt Wörner, Peter Sefrin: Hypovolemic shock - causes, symptoms and therapeutic consequences, clinician 2011; 40 (1): 36-41, DOI: 10.1055 / s-0031-1272861, Georg Thieme Verlag Stuttgart / New York, (accessed August 28, 2019), thieme

ICD codes for this disease: R57ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.


Video: Managing cardiogenic shock (October 2022).