Shock: Classification, Pathophysiology, and Approach to Management

Kumar, Anand; Parrillo, Joseph E.

doi:10.1016/b978-032304841-5.50024-8

Cited by 17 publications

(13 citation statements)

References 295 publications

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“…It is often the final pathway of multiple disorders. 1 She did not have signs of pump failure or extracardiac obstruction. No evidence of active bleeding or systemic infection were present, so the most likely diagnosis was neurogenic shock (NS).…”

Section: Go To Sectionmentioning

confidence: 98%

“…NS can occur following spinal cord injury, as a result of sympathetic denervation leading to reduced sympathetic outflow and subsequent reduction in cardiac output and systemic vascular resistance. 1 It occurs more commonly in injuries above T6, but can also occur following thoracic and lumbar injuries. 2 The primary treatment for NS is fluid resuscitation and vasopressors.…”

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confidence: 99%

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et al. 2012

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A 61-year-old woman with a stable traumatic anterior L4 vertebral wedge fracture without spinal canal compromise was referred because of an intense and refractory pain at the level of fracture in spite of maximal medical therapy. MRI scans showed anterior wedging of L4 vertebral body involving the superior endplate with intact posterior wall ( figure 1A). Percutaneous vertebroplasty (PV) was indicated for her high surgical risk. Under general anesthesia, right L4 transpedicular PV was performed under X-ray fluoroscopy using polymethylmethacrylate (PMMA; volume injected 3 cm 3 ; SpinePlex ® ; Kalamazoo, MI).No critical leaks or lesions of the posterior cortex or the lateral recess were identifiable in postprocedure fluoroscopy.Two hours after PV, the patient presented an intense burning pain in both legs, Lhermitte sign, and tactile hypersensitivity associated with low blood pressure (50/30 mm Hg), respiratory rate (8 breaths/ minute), and body temperature (rectal temperature: 35.0°C), together with hypoxemia (SaO 2 : 75%, in room air) and sinus tachycardia (heart rate 141/ minute). The initial symptoms were followed by sustained (35-45 seconds) and almost continuous muscle spasms in bulbar, pharyngolaryngeal, intercostal, paravertebral, and leg muscles, spontaneous and in response to minimal stimuli, stiffness of the body, lockjaw, frothing of the mouth, opisthotonus, bilateral Babinski sign, and generalized hyperreflexia. The patient was fully conscious during these episodes. During severe spasms, there was respiratory arrest. The patient was immediately referred to the neurointensive care unit (NICU). She was intubated and mechanically ventilated.

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Section: Go To Sectionmentioning

confidence: 98%

Section: Go To Sectionmentioning

confidence: 99%

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et al. 2012

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“…Phenylephrine may be especially useful when there is tachycardia, as the drug causes a reflux decrease in heart rate. Phenylephrine progressively increases systemic vascular resistance without affecting cardiac output initially, but later needs close monitoring of the cardiac effects because of the concomitant myocardial depression (77,78).…”

Section: Vasopressor Therapymentioning

confidence: 99%

Hypotension and multiple organ dysfunction syndrome

Sharma

Eschun

2008

Journal of Organ Dysfunction

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Multiple organ dysfunction syndrome (MODS) is characterized by progressive but potentially reversible physiologic dysfunction of two or more organ systems following resuscitation from an acute life-threatening event. Improved understanding of the pathogenesis of MODS has led to the development of new therapies that place importance on early identification and aggressive management. Our understanding of MODS has grown enormously over the past two decades. Presently MODS is deemed to be as much a disease paradigm as a syndrome that follows systemic activation of an adaptive host stress response to a catastrophic event. The exaggerated systemic inflammatory host response, induced by the infecting organisms or a non-infective insult, unleashes inflammatory mediators that are the key players in the pathogenesis of systemic inflammatory response syndrome (SIRS) and MODS. Sepsis, SIRS and their sequela, MODS, represent a continuum of clinical syndromes encompassing systemic inflammation, coagulopathy and hemodynamic abnormalities. The injurious insult to the human body promotes a vicious cycle of anomalous metabolic molecular physiology comprising increased oxygen demand and inadequate oxygen supply. Standard MODS therapy includes supportive treatment such as fluid resuscitation, administration of vasopressors (adrenergic and non-adrenergic drugs), and respiratory and renal support. This review emphasizes approaches to the early recognition, diagnosis and therapeutic management of sepsis and ensuing MODS, giving the clinician the most contemporary and practical approaches with which to treat these patients.

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“…Obstructive shock is typically attributed to extracardiac aetiologies such as cardiac tamponade, tension pneumothorax, constrictive pericarditis and mechanical ventilation due to an obstructive physiology that leaves the heart with an impaired diastolic filling 1. Massive pulmonary embolism, acute pulmonary hypertension, aortic dissection and systemic embolisation cause obstructive shock by increasing the afterload state and ultimately resulting in dysfunctional cardiac contractility 1.…”

Section: Introductionmentioning

confidence: 99%

“…Massive pulmonary embolism, acute pulmonary hypertension, aortic dissection and systemic embolisation cause obstructive shock by increasing the afterload state and ultimately resulting in dysfunctional cardiac contractility 1. Rarely is malignancy considered in the differential diagnosis of obstructive shock, except when a large intrathoracic obstructive tumour is identified as having direct occlusion of the vena caval system or a malignant pericardial effusion results in tamponade 1. Lymphoma, especially when systemic vasculature is involved, has been rarely associated with obstructive shock 1–3.…”

Section: Introductionmentioning

confidence: 99%

Massive splenomegaly and lymphopenia: a unique case of obstructive shock

2013

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SUMMARYWe present a patient with intravascular large B-cell lymphoma (IVLBCL)-induced obstructive shock. This case represents a unique presentation of the disease, while highlighting the difficulty of establishing the diagnosis. Although there was a high clinical suspicion for a lymphomatous process, the obstructive shock component of the patient's presentation was perplexing. It was not until the autopsy reports demonstrated lymphocytes within the pulmonary vasculature that the clinical picture of altered mental status, weight loss and obstructive shock were unified to the diagnosis of intravascular large B-cell lymphoma. BACKGROUND

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Shock: Classification, Pathophysiology, and Approach to Management

Cited by 17 publications

References 295 publications

Clinical Reasoning:

Clinical Reasoning:

Hypotension and multiple organ dysfunction syndrome

Massive splenomegaly and lymphopenia: a unique case of obstructive shock

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