Types and Effects of Shock

Shock means that blood is having trouble circulating throughout the body. It is a medical emergency that can progress rapidly. Shock can be life-threatening, with up to 1 out of 5 people dying as a result.

Low blood pressure and a change in mental state, such as confusion, sleepiness, or unconsciousness, are common signs or symptoms of shock. The underlying causes and types of shock can produce other signs and symptoms. Causes include blood loss, fluid loss, severe allergic reaction, severe reaction to an infection, heart attack, and spinal cord injury.

In this article, you'll learn what can cause shock, what symptoms spell emergency for each type, the first-line treatments when facing an emergency from shock, and more.

Types of Shock and Their Causes

Shock can be grouped into four types related to the underlying cause, some of which have subtypes. They are:

• Hypovolemic shock
• Distributive shock
• Cardiogenic shock
• Obstructive shock
  

Hypovolemic shock occurs when you lose 15% or more of your blood or body fluid volume. With this, there isn't sufficient blood volume to circulate.

Hemorrhagic shock is a subtype of hypovolemic shock in which there is dramatic blood loss internally or externally. Causes include trauma (cuts, gunshot wounds, crush injuries) or serious bleeding from a rupture, such as during childbirth or from a ruptured spleen.

Other kinds of fluid loss can cause hypovolemic shock. You may find yourself in hypovolemic shock in cases of long-term diarrhea or severe vomiting.

Distributive shock occurs when there's sufficient blood volume, but the blood vessels widen too much, which causes issues in getting the blood to the needed areas. The following three subtypes have different sets of causes:

• Septic shock: The response to an infection causes widespread issues with the vascular system.
• Neurogenic shock: A loss of nervous system activity slows the heart rate and allows the blood vessels to dilate (widen). It is often due to a spinal cord injury from a motor vehicle accident, fall, sports injury, or assault.
• Anaphylactic shock: This is a severe reaction to substances you are allergic to, such as nuts, dairy, fish, bee stings, or medications such as antibiotics or anesthetics.

Cardiogenic shock occurs when the heart cannot sufficiently pump oxygen-rich blood around the body. Your pulse slows, and your blood pressure drops. This often occurs due to a heart attack but can also be caused by heart failure, blood clots in the lungs, or chest injuries.

Obstructive shock involves something impeding normal blood flow. Numerous conditions can cause it, including fluid around the heart (cardiac tamponade), a clot stopping blood flow to the lungs, a heart valve too narrow to allow enough blood through, or when blood flow is reduced by increased pressure in the chest.

Emergency Symptoms of Each Type of Shock

Signs and symptoms of shock depend on the type. The stage of shock will also display different signs and symptoms. In an early stage, symptoms may still be relatively mild. But if not treated immediately, shock can progress and may rapidly become life-threatening.

In general, lack of blood flow to the cells and organs of the body leads to signs and symptoms of shock. Without enough oxygen-rich blood, tissue damage can occur and result in further effects.

Hypovolemic Shock

Symptoms may include anxiety, paleness, and feeling somewhat shaky when a minimal amount of blood or body fluids have been lost. With more loss of fluids or blood, serious signs and symptoms can include increased heart rate, rapid breathing, a bluish tinge to lips and fingernails, confusion, dizziness, weakness, and eventually losing consciousness.

Distributive Shock

With distributive shock the symptoms you experience will depend upon what's causing this, be it septic, neurogenic, or anaphylactic shock.

Septic Shock

Early symptoms may be limited to chills, weakness, increased breathing rate, and rapid heartbeat. This becomes an emergency, where you should call 911 if the following symptoms occur:

• A feeling of confusion or disorientation
• Extremely low blood pressure, leading to dizziness when standing
• Skin becoming pale, cold, and clammy
• Digestive disturbances such as diarrhea, nausea, and vomiting.

Neurogenic Shock

In cases of neurogenic shock, which may occur with a spinal cord injury, here's what to watch for:

• Low blood pressure
• Slow, irregular heart rate
• Issues with body temperature (often low body temperature)

Anaphylactic Shock

In anaphylactic shock, the likely signs are:

• Experiencing light-headedness or feeling faint
• A swelling or closing of the tongue, throat, or mouth
• Development of an itchy or red rash
• Whistling noise while breathing
• Digestive issues like nausea or vomiting or stomach pain
• Unconsciousness

Cardiogenic Shock

When someone is experiencing cardiogenic shock, the heart is not pumping a sufficient amount of blood for the entire system. Symptoms include the following:

• Feeling pressure or pain in the chest
• Rapid breathing
• Increased pulse
• Sweating
• Decreased urination
• Feeling lightheaded
• Unable to concentrate
• Confusion and agitation
• Trouble breathing
• Cool pale or blotchy skin
• Faint pulse

Obstructive Shock

With obstructive shock pressure on the blood vessels from within the body keep the organs from getting the oxygen they need. The symptoms here may seem as if they can apply to other forms of shock and may seem modest at first. Here are some of the symptoms that can occur with obstructive shock:

• Difficulty breathing
• Low blood pressure
• Rapid pulse
• Confusion
  
• Chest pain

Emergency Treatment of Shock

If someone is in shock, the goal is to ensure the organs get enough blood and maintain blood pressure. Take the following steps until emergency responders arrive:

• Call 911 or the local emergency number.
• Check the person's breathing and pulse. Start cardiopulmonary respiration (CPR) and rescue breathing if needed.
• Don't move the person if you think they have a spinal injury.
• If it is possible to move them without causing harm, place them on their back and lift their legs to be higher than their head. If they drool or vomit, turn their head to one side so they don't choke.
• Keep them warm by covering them with a blanket or jacket.
• Provide first aid for injuries and illnesses as needed until responders arrive.
• Don't give them anything to eat or drink.
  

The EMTs or emergency room personnel will aim to restore fluids, keep the person warm, and administer medications to raise blood pressure (when appropriate). The underlying cause and type of shock will dictate further treatment.

Complications

Even with immediate treatment, shock needs to be taken very seriously. It can lead to organ damage, particularly in vulnerable populations such as older people, which can ultimately result in death.

A young, healthy person who goes into shock due to accidental blood loss will recuperate 90% of the time, but an older person who is in shock from cardiac arrest may not survive even if treated promptly.

Rehabilitation and Recovery

Once you are successfully treated for shock, you may need rehabilitation to strengthen any organs that have been affected. For example, those with heart disease who have been in cardiogenic shock may need to undergo cardiac rehabilitation to build up their hearts and help keep them out of the hospital going forward.

After experiencing sepsis, you'll need time to heal in the hospital, recoup your strength, and learn to move around again. Your healthcare provider may also offer a rehabilitation plan for you to follow once you return home.

Keep in mind this will take time. You may find you're still weak and have trouble moving around during recovery.

Summary

In cases of shock, insufficient blood gets to the organs to supply oxygen and other nutrients. The four types of shock are hypovolemic, distributive, cardiogenic, and obstructive. Subtypes of distributive shock include septic shock, anaphylactic shock, and neurogenic shock.

Causes include blood loss, fluid loss, allergic reaction, systemic reaction to infection, spinal cord injury, heart attack, heart failure, and pressure around the heart or chest. Different signs and symptoms occur depending on the type of shock.

Shock is a medical emergency. When waiting for help to arrive, it's important to ensure that the vital organs get enough blood by elevating the legs when possible. The emergency responders will assess the person, begin treatment, and transport them to a hospital. After surviving shock, it may take a while to recuperate and require a recovery plan.