Circulatory shock - causes, first aid and treatment

What symptoms occur in a circulatory shock and what immediate measures are important

The circulatory shock describes an absolute state of emergency of the body's cardiovascular system. Since it can lead to complete organ failure without appropriate countermeasures, the circulatory shock always forms a medical emergency, which must be promptly supplied. Details on the topic offers this guide.

contents

• What symptoms occur in a circulatory shock and what immediate measures are important
• definition
• Causes of a circulatory shock
• Cardiogenic shock
• Hypovolemic shock
• Distributive shock
• Symptoms of circulatory shock
• First aid and therapy of circulatory shock
• Diseases in circulatory shock

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 constriction of the peripheral (peripheral) capillaries takes place in order to stabilize the blood pressure in the middle of the body, ie the center of vital organs. However, this mechanism has the consequence that the tissue of the periphery is less perfused and thus suffers from an increasing shortage of oxygen (hypoxia).

A circulatory shock is a medical emergency and the emergency doctor should be contacted immediately. (Image: Gina Sanders / fotolia.com)

Important metabolic end products (especially lactate) can no longer be removed due to the lack of supply and are deposited. The resulting condition is also referred to as hyperacidity (metabolic acidosis) and leads in the further course to increased fluid leakage into the tissue, resulting in a further drop in blood pressure. The oxygen supply of the body thus deteriorates increasingly, while the carbon dioxide content of the blood decreases more and more.

Peripheral hyperacidity resulting from circulatory shock can also cause a build-up of blood in the small capillaries, which can lead to dangerous vascular occlusions (microthrombi). In addition, the dysfunction in the body household provoke an increased consumption of coagulation factors, which are needed for blood clotting. This results in an increased bleeding tendency.

Once the body is in this shock spiral, it can no longer free itself without medical intervention and it comes to a multi-organ failure, which eventually leads to the death of those affected. For this reason, it is vital to recognize the signs of a circulatory shock as early as possible and to counteract it.

Causes of a circulatory shock

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

• Cardiogenic shock - The circulatory 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 by numerous accident scenarios, especially in the area of ​​the brain, which serves as a control center for any cardiovascular functions. On the other hand, certain underlying diseases can not be ruled out as the cause of the cardiovascular shock. This applies in particular to disease-related organ dysfunctions.

Cardiogenic circulatory shock is caused by severe cardiac dysfunction. (Image: Gina Sanders / fotolia.com)

Cardiogenic shock

Cardiogenic shock is caused by a cardiac malfunction, which 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. Body organs and tissue structures are no longer adequately supplied with blood and are only poorly supplied with oxygen and nutrients.

A corresponding decrease in the cardiac pumping force may be due to numerous damage to the heart. Conceivable are for example:

• Congenital heart valve defects
• Heart failure (heart failure)
• Arrhythmia
• Pericardial effusion (accumulation of fluid around the pericardium)
• Vascular constrictions of the heart (e.g., by coronary heart disease)
• Inflammation of the heart (e.g., endocarditis or myocarditis)

All these diseases affect the cardiac pumping power enormously and lead in the final stages of the disease to massive oxygen deficiency due to insufficient blood flow. In the worst case, the cardiovascular shock is preceded by a heart attack.

In addition to heart disease, cardiogenic shock should not underestimate pulmonary complaints as a cause. Very often, cardiovascular functionality is limited by possible respiratory problems. This is especially common pneumothorax involved. Air accumulates in the pleural space between the lungs and the heart, which can cause long-term extreme functional limitations of the heart. Also pulmonary edema and pulmonary embolism are able to cause cardiogenic shock in the advanced stage or in extreme disease progression. In the worst case, the state of shock indicates one lung tumor down.

Hypovolemic shock

Hypovolemic shock is also referred to as a volume-loss shock and is based on an acute, increased fluid loss. An adult can survive about 20% fluid loss (equivalent to about one liter) without damage in good constitution, because this body can still compensate for this fluid loss itself. However, if the fluid loss is above, this results in a shock situation. The hypovolemic shock in children is particularly fast-threatening.

For example, massive internal bleeding in the brain after an accident can lead to hypovolemic shock. (Image: Bits and Splits / fotolia.com)

Typical health complaints that can cause such a shock from extreme fluid loss are, for example, severe internal and external bleeding, as they are especially severe accidental injuries occur. For example, if a massive car brain hemorrhage occurs in a car accident, a hypovolemic shock is a very dreaded complication.

Also accidental intestinal bleeding, about after Acts of violence with grave injury Sharp-edged objects in the kidney, liver or intestine cause shock-inducing fluid loss. The situation is similar with large-scale burns. Experience has shown that the resulting wound surfaces are massively wet and thus deprive the body of large quantities of fluid. Furthermore, extreme diarrhea (for example gastrointestinal influenza), persistent vomiting and dehydration as the cause of hypovolemic shock can not be ruled out.

Distributive shock

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

Sepsis is a septic shock that forms a form of the so-called distributive circulatory shock. (Image: Zerbor / fotolia.com)

Septic shock

As a result of a localized or whole-body infection infection occurs here after the antigen-antibody reaction to a release of messengers. The exact course of a septic shock has not yet been conclusively explored. However, it is known that the messengers cause the following reactions:

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

It is believed that the body is severely weakened by infection-related inflammation in a septic shock and consequently is no longer able to fight the inflammation at the site of the incident. The body therefore compensatorisch pours more and more inflammatory messengers, which then flood the bloodstream. For example, a septic shock can develop in the context of many infectious and inflammatory diseases. In the area of ​​internal organs, this is especially true of

• lung infection,
• cholecystitis,
• Peritonitis
• and pancreatitis

as particularly risky. Rarely severe infections such as cholera or pulmonary embolism are also responsible. In addition, too surgery complications as a trigger of septic shock conceivable. Similar to the hypovolemic shock also come burns as a cause into consideration.

Anaphylactic shock

In addition to the septic shock is also the anaphylactic shock as a frequent trigger of a distributive shock spiral. It occurs in the context of an allergy and is therefore caused by an excessive immune reaction of the body to allergens. The immune system here classifies the corresponding allergens as potentially dangerous and releases excessive amounts of messenger substances (mainly histamine), which in turn cause an excess of immune reactions. Among other things, this leads to a widening of the vessels and the resulting drop in blood pressure. Also a constriction of the bronchial tubes and resulting dyspnoea are typical for the anaphylactic shock. The body reacts to this usually with an increase in the heart rate, to compensate for the drop in blood pressure and respiratory distress. If this condition remains untreated, a circulatory shock is inevitable.

Sudden onset of facial blanching and nausea through to vomiting are possible side effects of circulatory shock. (Image: chombosan / fotolia.com)

Symptoms of circulatory shock

The alarming complaints during a circulatory shock are usually quite clear. Above all, a pale face, a sharp drop in body temperature and cold sweats indicate the dangerous state of shock. Overall, the following complaints may occur:

• pallor,
• cold skin,
• Chills / Freeze,
• cold sweat,
• inner unrest,
• extreme circulatory problems up to collapse,
• Confusion and tiredness,
• Lose consciousness,
• nausea
• and vomiting.

Important: A circulatory shock is always an emergency. In addition, persistent oxygen deficiency can cause tissue necrosis and putrefaction in the body if the shock is not treated in time. If you have any symptoms, call an emergency doctor immediately!

The circulatory shock is diagnosed by the emergency physician mostly by mere gaze diagnosis in combination with a blood pressure and pulse measurement. If those affected are still able to hear the arrival of the emergency doctor, the emergency staff will usually ask for additional information regarding possible health problems and symptoms. After the implementation of appropriate emergency measures is then usually a stationary monitoring using ECG. The duration of the inpatient stay depends on the underlying cause, for the determination of which also imaging measures and laboratory tests, for example on the basis of blood tests, are used.

First aid and therapy of circulatory shock

Although critical emergency response to a circulatory shock must be carried out by professional paramedics, there are some first-aid measures that individuals can use to stabilize the patient:

Is the cause cardiogen conditions, bring the person in a quiet position with an upper body. Often, those affected take this attitude independently. In addition, tight clothes can be opened and fresh air taken care of.

Is the cause hypovolemic condition, Bring affected persons into the shock situation with a flat upper body and slightly elevated legs. In addition, obviously severely bleeding wounds should be covered sterile and provided with a pressure bandage.

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

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

In hypovolemic shock, balancing fluid loss via infusions is usually a fundamental part of treatment. (Image: bilderstoeckchen / fotolia.com)

Drug therapy in a circulatory shock

The drug therapy depends entirely on the cause of the circulatory shock. Cardiogenic shock focuses on the causative treatment of the causative disorder. In addition, an external supply (oxygen goggles, oxygen mask, respirator) restores sufficient oxygen supply to the body, and those affected are calmed or even sedated by appropriate medication.

The acute therapy of hypovolemic shock consists of balancing the fluid loss from the outside. Most often this happens through infusion solutions applied via the vein. In addition, the cause of the hypovolemia is clarified and its elimination initiated, for example by the administration of antibiotics or an adequate wound care. In the case of septic shock, the use of antibiotic drugs is also important. In addition, the cardiovascular parameters and the fever are treated symptomatically here.

Anaphylactic shock is treated by the administration of antihistamines and cortisone inhalants or infusion solutions. In addition, the oxygen supply is ensured by external routes.

Operative treatments

Circulatory shock surgery may be considered for a variety of causes. For example, internal and external bleeding, which then necessitate surgical wound closure. The same applies to severe burns. In the case of a heart attack, a stent system in the coronary arteries may be required. Stents are artificial elements for vascular dilation, which improves the blood circulation and thus the oxygen supply of the body.

If fluid accumulation or pneumothorax is present, the surgical measures are most likely to be derived by drainage of the fluid or air. Furthermore, organ resections or organ transplants are conceivable, provided that the corresponding organs are threatened with failure. An example of this would be end-stage gallbladder inflammation.

Of course, surgery for a circulatory shock always requires a thorough benefit-risk analysis, as it always presents an additional burden on the body, which is already under massive stress. Often, especially with cardiogenic causes, they are the only salvation for the patients.

From the Bach flower therapy so-called rescue drops or globules can be used for the concomitant treatment of circulatory shock. (Image: oconairekat / fotolia.com)

Naturopathy in circulatory shock

If the affected person is fully conscious during a circulatory shock, alert, responsive and stable on the circulation, the Rescue essences from the Bach flower assortment can be used with their consent. This composition of 5 different Bach flower essences available as drops or globules can support the body in acute stress situations and, for example, reduce the panic and anxiety that occur in the circulatory shock. It should be noted, however, that Rescue drops may only be used as a supportive measure and in no case replace the medical treatment and care provided by expert medical staff and paramedics.

Diseases in circulatory shock

: Heart valve failure, heart failure, arrhythmia, pericardial effusion, coronary heart disease, endocarditis, myocarditis. Pneumothorax, pulmonary edema, pulmonary embolism, lung tumor, accidental injury, diarrhea, vomiting, dehydration, sepsis, anaphylactic shock, infectious diseases. (Ma)