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User:It's gonna be awesome/Combined shock

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Combined shock refers to a combined form of clinical shock that is contributed by multiple non-clinical shock types or when underlying disorders being added to a non-clinical shock. It can also refer to a severe shock exacerbated by several types of clinical shock[1].

Although shock is divided into four types, people, in clinical settings, may present a combination of various shock types. Thus, a patient can actually receive a diagnosis of the combined shock. [2]

Examples[edit]

A severe infection can dispose a person in both dehydration as well as vasodilation which are initially attributed to hypovolemic shock and distributive shock, respectively, besides septic shock.[3] Hemorrhage shock because of blood loss from an open wound may be complicated by the distributive shock of systemic inflammatory symdrome or fat embolism. People with cardiomyopathy may seem like having hypovolemic shock due to excessive diuresis and in combination with decompensated tachycardia and/or stroke volume. [4][5] Enlarged spleen may partially or completely block the blood flow in the artery causing bruit or obstructive shock, respectively. [6][7][8] A spinal cord injured person may suffer not only neurogenic shock as a result of dysautonomia due to the spinal cord trauma but also myocardial depression because of significant increase in visceral sympathetic activity with coronary artery constriction from autonomic dysreflexia which could turn out into cardiogenic shock. [9][5] People with ruptured left ventricular free wall aneurysm can have cardiogenic shock from heart failure. [10][11][12] Cardiac tamponade associated with ruptured aneurysm in heart can lead to obstructive shock or hypovolemic shock when blood is trapped in or lost but absent from pericardial sac.[13][14][15][16][17] Undetectable gastric ulcer that is perforated into the pericardium is rare but can result in shock. [18] A dinstributive shock featuring low vascular resistance may further combine an obstructive shock and cardiogenic shock when massive volume resuscitation leads to abdominal compartment syndrome as well as acute right heart syndrome. [19][20][20][21] Chest trauma more often than not leads to a combined shock of obstructive shock featuring tension pneumothorax and hypovolemic shock characterized by massive bleeding. [22][23][24][25][26]

Signs and symptoms[edit]

  • Fluid-responsive and non fluid-responsive hypotension. [1]
  • Drug-resistant hypotension. [1]

Cause[edit]

  • Enduring sub-clinical shock ensued from the late identification or improper treatment for the preceding shock. Frankly, if the root cause of shock in the early days wasn't well-treated despite adjustments of the macro-hemodynamic variables, the ensuing sub-clinical shock may end up evolving into a new round of physical deterioration or refractory shock. [1]

[27]

Management[edit]

Reparation of the metabolic acid-base imbalance, and rectification of the patient's state deficient in nutrition. [28]

Reference[edit]

  1. ^ a b c d Bonanno, FabrizioGiuseppe (2011). "Clinical pathology of the shock syndromes". Journal of Emergencies, Trauma, and Shock. 4 (2). Medknow: 233. doi:10.4103/0974-2700.82211. ISSN 0974-2700. PMC 3132364. PMID 21769211.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  2. ^ Zanobetti, Maurizio; De Villa, Eleonora; Lazzeretti, Delia; Conti, Alberto; Pini, Riccardo (2013-05-23). "A Case of Combined Septic and Obstructive Shock: Usefulness of Bedside Integrated Cardiothoracic Emergency Ultrasonography". Case Reports in Emergency Medicine ( This source from PubMed is licensed under the Creative Commons Attribution 4.0 International License.). 2013. Hindawi Limited: 1–3. doi:10.1155/2013/154861. ISSN 2090-648X. PMC 3677011. PMID 23762655. {{cite journal}}: External link in |type= (help)
  3. ^ "Sepsis Treatment". nhs.uk. 2018-10-03. Retrieved 2019-02-25.
  4. ^ Kumar, Anand; Parrillo, Joseph E. (2008). "Shock: Classification, Pathophysiology, and Approach to Management". Critical Care Medicine. Elsevier. pp. 379–422. doi:10.1016/b978-032304841-5.50024-8. ISBN 978-0-323-04841-5.
  5. ^ a b "Definition-classification-etiology-and-pathophysiology-of-shock-in-adults". UpToDate. Retrieved 2019-02-25.
  6. ^ Huprikar, N. A.; Kurtz, M. T.; Mount, C. A. (2013-10-30). "Massive splenomegaly and lymphopenia: a unique case of obstructive shock". BMJ Case Reports. 2013 (oct30 1). BMJ: bcr2013201643. doi:10.1136/bcr-2013-201643. ISSN 1757-790X. PMC 3822246. PMID 24172780.
  7. ^ "Diagnostic significance of abdominal murmurs.", Canadian Medical Association Journal ( This source from PubMed is licensed under the Creative Commons Attribution 4.0 International License.), 98 (3): 172–3, 1968-01-20, ISSN 0008-4409, PMC 1923762, PMID 5293830 {{citation}}: External link in |type= (help)
  8. ^ Julius, S.; Stewart, B. H. (1967-05-25). "Diagnostic Significance of Abdominal Murmurs". New England Journal of Medicine ( This source from PubMed is licensed under the Creative Commons Attribution 4.0 International License.). 276 (21). New England Journal of Medicine (NEJM/MMS): 1175–1178. doi:10.1056/nejm196705252762104. ISSN 0028-4793. S2CID 37119830. {{cite journal}}: External link in |type= (help)
  9. ^ Ho, C P; Krassioukov, A V (2010-02-02). "Autonomic dysreflexia and myocardial ischemia". Spinal Cord. 48 (9). Springer Nature: 714–715. doi:10.1038/sc.2010.2. ISSN 1362-4393. PMID 20125109. S2CID 9214067.
  10. ^ Uchimuro, Tomoya; Osako, Motohiko; Gotou, Tetsuya; Yamada, Toshiyuki; Yoon, Ryogen (2017). "Left ventricular free wall rupture after surgery for ventricular septal rupture". Asian Cardiovascular & Thoracic Annals. 26 (9). SAGE Publications: 697–700. doi:10.1177/0218492317692897. ISSN 0218-4923. PMID 29214816. S2CID 12583405.
  11. ^ Yamada, H.; Sakurai, A.; Higurashi, A.; Takeda, K. (2015-01-27). "Cardiac CT for intraseptal pseudoaneurysm: impending double rupture of ventricular septum and left ventricular free wall". BMJ Case Reports. 2015 (jan27 2). BMJ: bcr2014207352. doi:10.1136/bcr-2014-207352. ISSN 1757-790X. PMC 4322251. PMID 25628320.
  12. ^ M, Dewulf; Al., Et (2019-02-25). "Conservative Treatment of Left Ventricular Free Wall Rupture". NCBI. PMID 26763845. Retrieved 2019-02-25.
  13. ^ Cárdenes León, Aridane; Gallardo Santos, Elena; Prada Osorio, Roland; López Pérez, Marta; Martín Lorenzo, Pedro Luis (2017). "Cardiogenic Shock and Cardiac Tamponade in the Context of Influenza A Myopericarditis". Revista espanola de cardiologia (English ed.). 70 (12). Elsevier BV: 1149–1151. doi:10.1016/j.rec.2017.01.031. ISSN 1885-5857. PMID 28454888.
  14. ^ Pich, H.; Heller, A.R. (2015). "Obstruktiver Schock". Der Anaesthesist (in German). 64 (5). Springer Nature: 403–419. doi:10.1007/s00101-015-0031-9. ISSN 0003-2417. PMID 25994928. S2CID 39461027.
  15. ^ Wacker, David A.; Winters, Michael E. (2014). "Shock". Emergency Medicine Clinics of North America. 32 (4). Elsevier BV: 747–758. doi:10.1016/j.emc.2014.07.003. ISSN 0733-8627. PMID 25441032.
  16. ^ Azarbal, Amir; LeWinter, Martin M. (2017). "Pericardial Effusion". Cardiology Clinics. 35 (4). Elsevier BV: 515–524. doi:10.1016/j.ccl.2017.07.005. ISSN 0733-8651. PMID 29025543.
  17. ^ Appleton, Christopher; Gillam, Linda; Koulogiannis, Konstantinos (2017). "Cardiac Tamponade". Cardiology Clinics. 35 (4). Elsevier BV: 525–537. doi:10.1016/j.ccl.2017.07.006. ISSN 0733-8651. PMID 29025544.
  18. ^ Schulte-Hermes, M.; Klein-Wiele, O.; Vorpahl, M.; Seyfarth, M. (2018). "Acute tension pneumopericardium due to perforated gastric ulcer without diagnostic radiographic findings 72 h before perforation". Journal of Cardiology Cases. 18 (6). Elsevier BV: 201–203. doi:10.1016/j.jccase.2018.07.007. ISSN 1878-5409. PMC 6306572. PMID 30595772.
  19. ^ Wang, XT; Liu, DW; Zhang, HM; Long, Y; Guan, XD; Qiu, HB; Yu, KJ; Yan, J; Zhao, H; Tang, YQ; Ding, X; Ma, XC; Du, W; Kang, Y; Tang, B; Ai, YH; He, HW; Chen, DC; Chen, H; Chai, WZ; Zhou, X; Cui, N; Wang, H; Rui, X; Hu, ZJ; Li, JG; Xu, Y; Yang, Y; Ouyan, B; Lin, HY; Li, YM; Wan, XY; Yang, RL; Qin, YZ; Chao, YG; Xie, ZY; Sun, RH; He, ZY; Wang, DF; Huang, QQ; Jiang, DP; Cao, XY; Yu, RG; Wang, X; Chen, XK; Wu, JF; Zhang, LN; Yin, MG; Liu, LX; Li, SW; Chen, ZJ; Luo, Z (2017-12-01). "[Experts consensus on the management of the right heart function in critically ill patients]". Zhonghua Nei Ke Za Zhi (in Chinese). 56 (12): 962–973. doi:10.3760/cma.j.issn.0578-1426.2017.12.017 (inactive 2022-10-28). ISSN 0578-1426. PMID 29202543.{{cite journal}}: CS1 maint: DOI inactive as of October 2022 (link)
  20. ^ a b Vadakel, H; Rizzolo, D (2013). "Shock: early recognition and resuscitation are key". JAAPA : Official Journal of the American Academy of Physician Assistants. 26 (6): 21–4. doi:10.1097/01.JAA.0000430337.64530.da. ISSN 1547-1896. PMID 23805588. S2CID 36551127.
  21. ^ Hardaway, RM (2006). "Traumatic shock". Military Medicine. 171 (4): 278–9. doi:10.7205/MILMED.171.4.278. ISSN 0026-4075. PMID 16673737.
  22. ^ Horst, K.; Simon, T. P.; Pfeifer, R.; Teuben, M.; Almahmoud, K.; Zhi, Q.; Santos, S. Aguiar; Wembers, C. Castelar; Leonhardt, S.; Heussen, N.; Störmann, P.; Auner, B.; Relja, B.; Marzi, I.; Haug, A. T.; van Griensven, M.; Kalbitz, M.; Huber-Lang, M.; Tolba, R.; Reiss, L. K.; Uhlig, S.; Marx, G.; Pape, H. C.; Hildebrand, F. (2016). "Characterization of blunt chest trauma in a long-term porcine model of severe multiple trauma". Scientific Reports. 6 (1). Springer Nature. doi:10.1038/srep39659. ISSN 2045-2322. S2CID 12703650.
  23. ^ Frisoli, Tiberio M.; Afana, Majed; Mawri, Sagger; Hadid, Mazen; Sayed, Luay; O’Neill, William W.; Wang, Dee Dee; Parikh, Sachin; Khandelwal, Akshay; Alaswad, Khaldoon (2017). "Respect the Septal Perforator". JACC: Cardiovascular Interventions. 10 (10). Elsevier BV: e91–e92. doi:10.1016/j.jcin.2017.02.018. ISSN 1936-8798. PMID 28456700.
  24. ^ Mühling, B. (2017-07-27). "Stumpfes und penetrierendes Thoraxtrauma". Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen (in German). 88 (9). Springer Nature: 807–816. doi:10.1007/s00104-017-0470-8. ISSN 0009-4722. PMID 28752438.
  25. ^ Molnar, Tamas F. (2017). "Thoracic Trauma". Thoracic Surgery Clinics. 27 (1). Elsevier BV: 13–23. doi:10.1016/j.thorsurg.2016.08.003. ISSN 1547-4127. PMID 27865322.
  26. ^ Dennis, Bradley M.; Bellister, Seth A.; Guillamondegui, Oscar D. (2017). "Thoracic Trauma". The Surgical Clinics of North America. 97 (5). Elsevier BV: 1047–1064. doi:10.1016/j.suc.2017.06.009. ISSN 0039-6109. PMID 28958357.
  27. ^ Standl, Thomas; Annecke, Thorsten; Cascorbi, Ingolf; Heller, Axel R.; Sabashnikov, Anton; Teske, Wolfram (2018-11-09). "The nomenclature, definition and distinction of types of shock". Deutsches Ärzteblatt International. 115 (45). Deutscher Arzte-Verlag GmbH. doi:10.3238/arztebl.2018.0757. ISSN 1866-0452. PMC 6323133. PMID 30573009.
  28. ^ Schumer, W (1984). "Pathophysiology and treatment of septic shock". The American Journal of Emergency Medicine. 2 (1): 74–7. doi:10.1016/0735-6757(84)90112-8. ISSN 0735-6757. PMID 6517987.
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