Cardiogenic Shock Research Paper

Shock is a medical emergency in which the organs and tissues of the body are not receiving a sufficient flow of blood. This deprives the organs and tissues of oxygen (which is carried in the blood) and allows the buildup of waste products. Shock can result in serious damage or even death. ("Shock," 2008)

Shock is usually caused by three major categories of problems: cardiogenic (problems associated with the heart), hypovolemic (total volume of blood available to circulate is low), and septic shock (infection in the blood). Cardiogenic shock can be caused by any disease which prevents the heart muscle from pumping strongly enough to circulate the blood normally. Heart attack, disturbances of the electrical rhythm of the heart, and any kind

of mass which interferes with flow out of the heart are all things that affect the heart's ability to pump a normal quantity of blood. Hypovolemic shock happens when the total volume of blood in the body falls well below normal. This can happen when there is excess fluid loss, as in dehydration due to vomiting or diarrhea, diseases which cause excess urination (diabetes insipidus, diabetes mellitus, and kidney failure), extensive burns, blockage in the intestines, inflammation of the pancreas (pancreatitis), or severe bleeding anywhere in or throughout the body.

Septic shock can occur when an untreated or inadequately treated infection is allowed to grow in the body. Bacteria often produce toxins which can cause injury throughout the body. When large quantities of these bacteria, and the toxins, begin circulating in the bloodstream, every organ and tissue in the body is at risk of their damaging effects. "The most damaging consequences of these bacteria and toxins include poor functioning of the

heart muscles, widening of the diameter of the blood vessels, drops in blood pressure, activation of the blood clotting system that causes blood clots, followed by uncontrollable bleeding, damage to the lungs, causing acute respiratory distress syndrome, liver failure, kidney failure, and coma." (Weil, 2007)

Treatment of shock includes keeping the patient warm, with legs raised and head down (to improve blood flow to the brain), putting a needle in a vein in order to give fluids or blood transfusions, giving the patient extra oxygen to breathe, medications to improve the heart's functioning, and treating the underlying condition which led to shock. The most preventable type of shock is caused by dehydration during an illnesses with severe vomiting or diarrhea. Shock can be avoided by realizing that a patient who is unable to drink needs to be given fluids intravenously. Other types of shock are only preventable by preventing the underlying conditions, or monitor and manage those conditions well enough so that they never progress to the point of shock.

An anaphylactic shock is a rapidly progressing, life-threatening allergic reaction.

This allergic reaction can start within seconds of exposure, and rapidly develop to cause airway constriction, skin and intestinal irritation, and abnormal heart rhythms. An anaphylactic shock is caused by the release of histamine and other chemicals from mast cells. Mast cells are a type of white blood cell and they are found in tissues that regulate exchange with our environment. Mast cells have antibodies called IgE (immunoglobulin type E). IgE are made to detect environmental substances to which the immune system is sensitive. A substance that most people can tolerate, but others have an allergic response, is called an allergen. When IgE antibodies come together with allergens, they cause the mast cells to release histamine and other chemicals, which mix into all of the body's cells. This causes your body's vessels to leak fluid into surrounding tissues, causing the fluid accumulation, redness, and swelling. On smooth muscle cells of the airways and digestive system, they cause constriction. On nerve endings, they cause itching. (Molle, Durham, Kronenberger, & West-Stack, 2004)

In an anaphylactic shock, the life threatening response is due to extreme hypersensivity to the allergen. Exposure by ingestion, inhalation, or skin contact causes anaphylaxis. Specific causes are fish, shellfish, nuts, stings of bees, wasps, or hornets, vaccines, antibiotics, insulin, hormones, aspirin and latex.

Symptoms of an anaphylactic shock are hives, swelling of the tongue or mouth swelling of sinuses, difficulty breathing, wheezing, cramping, vomiting, diarrhea, anxiety, confusion, high BP, or loss of consciousness.

"Emergency treatment of anaphylaxis involves injection of epinephrine which helps constricts blood vessels and counteracts the effects of histamine. Oxygen can be given. Antihistamines can be used for skin rash, and amino-phylline for bronchial constriction. If the airway is obstructed, placement of a breathing tube would be needed as well." (Molle, Durham, Kronenberger, & West-Stack, 2004) The prognosis of an anaphylactic shock depends on how quickly emergency medical attention is given. However, death is possible from severe anaphylaxis. For those who receive rapid treatment, speedy recovery is likely. The only reliable method of preventing an anaphylactic shock is complete avoidance of the allergen. For insect allergies, it is recommended to learn nesting sites and habits. To prevent food allergies, have knowledge of prepared foods or dishes in which the allergen is likely to be present and careful observations and questioning about ingredients when dining out. Also, use of a Medi-Alert tag listing drug allergies is vital to prevent unintentional administration of drugs during a medical emergency. People prone to anaphylaxis should carry an "Epi-pen" that contains adrenaline for immediate injection.

In conclusion, both shock and anaphylactic shock are extreme medical emergencies that should be handled with effectiveness and precision. It is crucial for the medical professional to be educated on the steps needed to respond to this emergency. Additionally patients should be educated on steps to prevent these shocks, and how to properly contact medical personnel.