SHOCK

shock

Ques. 1        Describe Shock?

Ans.             Shock is a clinical state of circulatory collapse due to disparity of the vascular capacity and total blood volume. Surgical shock is a type of shock due to surgical operations. Trauma and diseases leading to excessive haemorrhage.

Ques. 2        What are the types of Shock?

Ans.             Type :

  1. Endotoxic (dangerous) – bacterial toxins.
  2. Anaphylactic – reaction to foreign proteins.
  3. Oligaemic or hypovolaemic, e.g. injury, burn, vomiting, severe haemorrhage.
  4. Neurogenic, e.g. acute anxiety, surgical colic and pains – blow over testis.

The essential Physio-pathology are decrease of cardiac minute volume, hypoxia of vital tissues, metabolic acidosis and hormonal reaction of body.

Stages of shock :

  1. Irreversible stage – Here the compensatory mechanism fails and death occurs invariably in spite of treatment. This is usually preceded by a progressive hypotensive stage, where blood pressure falls in spite of compensatory mechanism. If the shock in its reversible phase is not well treated by transfusion of fluid, plasma of blood, patient ultimately passes into the irreversible phase of shock.
  2. Compensated or reversible stage – The fall of blood pressure is being compensated by some mechanisms inside human body.

Clinical Features:

  1. Hypovolaemic shock – (i) Pupils are non-reacting and dilated, dimness of vision. (ii) Skin is cold and clammy, pallor. (iii) Rapid and shallow respiration, cyanosis is present. (iv) Intense thirst and occasional vomiting, tongue is dry and furred. (v) Rapid and thread pulse. (vi) Blood pressure falls. (vii) Tic-tac albumin in urine. (viii) Apathetic and quiet, consciousness, fine tremor, muscle twitching. (ix) Lusterless eyes and dull looking, eyeball sunken.
  2. Neurogenic shock – Fainting, generalized pallor, sweat on forehead, cold and clammy of limbs, slow and collapsible pulse with falling B.P.

Ques. 3        What Endotoxic Shock?

Ans.             Endotoxic or toxic shock –

  1. Temperature – high rise.
  2. History of infection/septicaemia.

Ques. 4        How can you manage a case of Shock?

Ans.             Management :

  1. Curative – (i) Undue loss of body heat should be prevented. (ii) Continuous observations of pulse rate, B.P., temperature, urinary output etc. (iii) Oxygen inhalation. (iv) Fluid replacement – (a) blood, (b) plasma, (c) 5% dextrose, (d) dextrose – saline. (v) Vasopressor or vasodilator druge. (vi) Control of haemorrhage. (vii) Removal of cause. (viii) Steroid. (ix) Physical and mental rest (Injection of morphine (10-15 mgm) should be given i.m. or I.V. (x) Head end low.
  2. Preventive – It is better to prevent the shock than to treat an established case – (i) absolute rest in post-operative stage, (ii) during operation-less exposure of abdominal viscera to the atmosphere; minimal use of anaesthetic drugs; no rough manipulation or organs; careful dressings of burnt areas etc. (iii) pre-operative blood or fluid transfusion after accurately calculating the loss, (iv) post-operative sedatives as a routine,

Ques. 5        Which Homoeopathic Remedies are given for Shock?

Ans.             Homoeopathic Remedies :

  • Hypericum – Tetanus, darting pains in back, contraction of muscles of various parts of body, resultant on injuries to nerves, tetanus following lacerations of skin, involving sensory nerves, shuddering all over, with desire to urinate, retention of urine.
  • Aconite – Injury with fright, followed by fever, fear of death and misfortune, great restlessness, cannot be pacified, all the senses excessively keen, pulse tense, thready and wiry, chilly when uncovered.
  • Helleborus – Shock after a blow or fall on the head, drowsiness, one pupil larger than the other, breathing heavy and slow, pulse full and easily compressed, from 3 to 6 p.m.
  • Carbo Veg – Collapse with Hippocratic countenance, cadaverous stools, stagnant circulation, coldness of surface; breath absolutely cold, and still, the patient, wants to be fanned though apparently dying, veins full of blood, scarcely perceptible pulse, loss of vision and hearing.

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