Classification, pathophysiology and principle of therapy of shock

Abstract

Shock is a clinical syndrome that results from lack of oxygen utilization or supply to vital organs resulting in hypoxia. Shock is associated with significant morbidity and mortality as if not treated timely can lead to multiple organ failure and death. The mortality rate of shock ranges from 20% to 50%. Shock has several pathophysiologies including intracardiac etiologies such as myocardial infarction, myopathy, or severe arrhythmia which produce altered maturation and cause heart failure while loss of internal or external fluid due to trauma or bleeding often results in hypovolemia. Also, obstruction by extracardiac causes and activation of inflammatory cascade can induce shock. The purpose of this research is to review the available information about the classification, pathophysiology and principle of therapy of shock. The major classification of shock includes cardiogenic, hypovolemic, obstructive and distributive shock. Distributive shock is further divided into three subclasses of septic, anaphylactic and neurogenic shock. Haemorrhagic shock is also the sub-type of hypovolemic shock. Each class of shock requires a specific treatment and timely management to prevent any further complications. Constant examination, resuscitation and re-evaluation are important in therapy of shock. To treat hypotension and to increase cardiac output, vasopressor drugs and inotropic adrenergic drugs continue to be the most widely used therapies. Endogenous catecholamines such as epinephrine, norepinephrine, and dopamine among other vasopressors have been shown to be effective in treating various types of shocks that are controlled as part of treatment for shock. Early diagnosis and prompt treatment can help in prevention of complications of shock also enhancing the recovery of patients.