Talk:Shock (circulatory)

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This

This article needs to mention psychological shock. -- Tarquin

Why, in medical terms shock refers to the physical part. However, if you feel the need to mention Post-traumatic stress disorder feel free to explain why. Nomen Nescio 15:54, 16 March 2006 (UTC)

mental shock is one type of medical shock. Post-traumatic is by definition, post-traumatic. not the same thing, is it? Also, that article doesn't use the word 'shock' once. -- Tarquin 16:33, 16 March 2006 (UTC)

If you do not refer to PTSD, what exactly do you mean? And in what Medical Textbook (Cecil, Harrison, Oxford Textbook of Medicine, et cetera) can I find this "mental shock?" As far as I know "shock" in medicine only refers to what this article discusses, although the popular use (this is not the same as what doctors use) is limited to the psychological disorder. Nomen Nescio 17:00, 16 March 2006 (UTC)

Perhaps Tarquin refers to someone who is catatonic? If someone says "psychological shock" that's what I would think of. —Traal 02:22, 18 September 2006 (UTC)

I agree with Tarquin – the word "shock" is used in a medical context to describe the body's physical reaction to immediate psychological stress. For example, you witness a terrible car accident. Over the course of the following two or three hours, you vomit several times and feel faint. This would be called "shock", and it has nothing to do with post-traumatic stress disorder. Witnesses to horrific events are often said to "have sustained no injury, but were treated for shock". Clearly this is a MAJOR medical usage of the term that should be included in the article! --Ecksemmess 14:34, 18 September 2006 (UTC)

I'm confused about the topic of shock. A friend of mine was hit by a car a few years back, and she told me that when she was 'in shock' she couldn't feel any pain and was having fun fiddling around with her broken pinky. That's about all she could tell me, but I want to know more. I looked here, but this article has no mention of it. The disambig page led to PTSD, but I don't think that's quite it either. In short, I agree with Ecksemmess that another section should be added. This is supposed to be a friggin' encyclopedia! If it is a major medical term, why isn't it explained or at least mentioned?

I would further like to point out that when you type "define:shock" into Google the very first definition is:

the feeling of distress and disbelief that you have when something bad happens accidentally;
"his mother's death left him in a daze"; "he was numb with shock"

Very good, but this is NOT! clinical shock, just as it isn't an electrical shock. The disambiguation link is there for this very reason, if you feel a page on Shock (psychological) is required, feel free. Also just looked through the Oxford Handbook of Clinical Medicine, and the only reference to shock is the clinical shock discussed here. So as a "major medical term" not being included in the major publication doctors here in Britain use is surely an indication that the medical fraternity do not use shock in this way. Panthro 01:51, 12 December 2006 (UTC)

The page Acute stress reaction describes this so I am linking the shock disambig page to it and mentioning that term on its page. 76.202.59.91 20:14, 11 August 2007 (UTC)

Four

I would like to remind all editors that shock is divided in FOUR types, as the article says. It would be helpfull if we keep all of these forms of shock and not delete the fourth: obstruction. Nomen Nescio 00:42, 27 March 2006 (UTC)

Is this POV or do you have verifiable sources as all the books and journals I have read state only three. I will leave it for now, but remove it unless you provide the said sources. Thanks. Panthro 19:17, 27 March 2006 (UTC)

Another point.. for obstructive shock Google has 864 hits. These factors stated CAUSE shock.. the same way that haemorrhagic shock is not a type in itself but part of hypovolaemic shock. But I am open to discussion on the matter. Panthro 19:24, 27 March 2006 (UTC)

• Incorrect, my Google says about 678,000 for obstructive shock. Nomen Nescio 01:59, 28 March 2006 (UTC)

If you wrap quotations around it - you will get the 800 odds... simply putting onstructive shock means google looks for "obstructive" and "shock". 893 for google.com, 899 for google.co.uk which compares to 146,000 for hypovolemic and 1,000,000+ for septic shock. I understand that this is not evidence per se, but it is interesting Even so, you have proven yourself the term exists (eMedicine is a very good site) and was not invented by me. Nomen Nescio 19:55, 29 March 2006 (UTC)

It is quite incorrect to state that distibutive shock is similar to hypovolaemia, undoubtedly they will lead on to hypovolaemia due to the compensatory mechanisms affecting the body.

Consider this: take a 1 liter bottle, fill it with water and you will have 1 liter of water with no room to spare. Then take a 2 liter bottle and empty the original 1 liter bottle into it. If I am not mistaken we will have 1 liter of water in a 2 liter bottle. Now, the amount of water is insufficient to fill the bottle, although we have not changed the volume of water. We change the volume the bottle can take and this is exactly what happens in distributive shock. By vasodilatation the volume our bloodvessels can take increases, but the volume of blood remains the same. Just as in the bottles there is a mismatch of volume and relative to the new volume of circulation there is not enough blood: hence relative hypovolemia! Nomen Nescio 19:55, 29 March 2006 (UTC)

"An internal source may be haemorrhage, intestinal obstruction, paralytic bowel or gross ascites."

I assume you deleted the above again on a whim of one piece of evidence.

Ascites - look it up if you don't know what it is. This is a massive fluid shift into the abdomen - occasionally called "third shifting".

Re: intestibal obstuction and paralytic ileus - this causes the accumulation of fluid in the bowel (it isn't getting absorbed vy the villi) - as a result there is dehydration and deranged electrolytes. Usually it is also results in vomiting - all leading to a decrease in circulating volume and therefore HYPOVOLAEMIA.

Do not revert something on a whim simply because you don't understand... a good editor will look up verifiable sources and then initiate a discussion.

I am sorry that some of your good changes to the previous revert have been removed - I will try to add them in..... Panthro 19:49, 27 March 2006 (UTC)

Oh and another thing, if you so strongly support the four shock types idea, then why have you stated under the treatment for obstructive shock

" fluid deficit is medically compensated by intravenous resuscitation"

Surely this is hypovolaemic shock?????? Panthro 19:53, 27 March 2006 (UTC)

First of all you might consider a less aggressive tone. For a student nurse to make such bold statements without having read one medical textbook on the subject is rather presumptuous.

How do you know I havent read "medical" textbooks? Who is being presumptive now?

I will gladly put the references in of the medical, pathophysiological, pathological textbooks and journal articles which state three types of shock.Panthro 18:50, 28 March 2006 (UTC)

Second, as to why I insist on four types is because that is what doctors have agreed upon.

Which doctors? In these textbooks?Panthro 18:50, 28 March 2006 (UTC)

Although I appreciate your effort and concede your sources have not heard of it the details can be found in the following medical textbooks: Intensive Care Medicine by Irwin and Rippe, The ICU Book by Marino, Fundamental Critical Care Support, A standardized curriculum of Critical Care, by the Society of Critical Care Medicine. Please read them before assuming I am wrong. Furthermore, your description of symptoms is not entirely correct based on my personal experience working in intensive care.

Cannot access those materials but I will give you the benefit of the doubt Panthro 18:50, 28 March 2006 (UTC)

Third, "An internal source may be haemorrhage, intestinal obstruction, paralytic bowel or gross ascites." is incorrect. Ileus leads to extravasation of fluid and dehydration, but seldom, if ever, to distributive shock.

hypovolaemic shock, not distributive Panthro 18:50, 28 March 2006 (UTC)

Remember hypovolaemia is not equivalent to shock. Why ascites leads to distributive shock entirely escapes me. Can you explain the mechanism? Ascites developes over time and many patients (cirrhosis, lymphoma or other malignancy) are not acutely ill.

I think if I remember correctly, it was gross untreated ascites, i.e. a massive fluid shift into the abdomen... Panthro 18:50, 28 March 2006 (UTC)

Fourth, "fluid deficit is medically compensated by intravenous resuscitation" was not inserted by me. Nomen Nescio 23:54, 27 March 2006 (UTC)

apologies for that... and for my tone. Panthro 18:50, 28 March 2006 (UTC)

Some observations:

1 In medicine doctors use the following textbooks as reference:

• Harrison's Principles of Internal Medicine, this is considered the principal resource for any condition in internal medicine
• Cecil Textbook of Medicine
• The Oxford Textbook of Medicine

2 In intensive care medicine doctors use these references

• Intensive Care Medicine by Irwin and Rippe, again the principal resource
• The ICU Book by Marino is a succinct book used a reference by those unable/unwilling to buy the Irwin and Rippe

3 You surely have looked in textbooks, however, since the ones I mention are the primary, if not only, references among doctors for any problem in internal medicine, I would suggest we adopt whatever these textbooks provide as definition and forms of shock.

4 Although you are correct in pointing out you referred to hypovolaemic shock, this still does not alter the fact that your assertions are incorrect. Both ileus and ascites do not present an acute and massive shift of fluid into the extravasal space. Hence they will cause dehydration (decrease of intravascular volume) but not shock.

5 Apologies accepted and do continue editing. But please consider your literature may not present an accurate and comprehensive discussion on medical conditions. Feel free to read about the conditions that are listed as examples of the types of shock. Nomen Nescio 20:21, 28 March 2006 (UTC)

Continuing with the idea of the listed literature possibly not being accurate or comprehensive, note that pre-hospital care providers in the US are taught that there are five, six, even seven types of shock:

- Hypovolemic
- Cardiogenic
- Neurogenic
- Psychogenic (sometimes considered a subset of Neurogenic shock)
- Respiratory Insufficiency (not described in Mosby's Paramedic Textbook)
- Anaphylactic
- Septic

(See, e.g., Emergency Care and Transportation of the Sick and Injured, 9th Ed. & Mosby's Paramedic Textbook, 2d Ed.)

As always, the point of the article needs to be that regardless of cause, shock is a lack of tissue perfusion which, left untreated, will cause the patient's death, and therefore constitutes a true medical emergency. Then, perhaps, the various "causes" of shock can be described, along with their possible treatments. Aramis1250 17:55, 28 September 2007 (UTC)

Undoubtedly there are sources using a different classification. Nevertheless, for obvious reasons, I think we should limit ourselves to medical literature since that is the standard on which all other healthcare workers' principles are based. Second, if you look at the mechanisms, contrary to the actual cause, you will find that the subtypes this article describes share the same mechanism with regard to how a specific type of shock develops.Nomen Nescio^{Gnothi seauton} 13:37, 29 September 2007 (UTC)

Quick note - I am an infrequent editor of wikipedia so I'm sure this isn't formatted correctly
This article is hopeless. There are a few correct facts but the overall article shows that no-one editing it really understands what it is - especially given that the discussion page can't even agree on what they are talking about. 'Psychological shock' (PTSD, whatever else) has no place in this article. Circulatory shock refers to one thing: systemic hypoperfusion. This can be expanded in a number of ways (some of which are mentioned in the article). I will try and clean it up if I get a chance in the next few days / weeks.
—Preceding unsigned comment added by 110.32.41.171 (talk) 08:00, 9 December 2009 (UTC)

Revert

Sorry to hinder your work yet again, but you are making several mistakes. 1 An Intra-aortic balloon pump[1] is inserted through the arteria femoralis and NOT the v. jugularis or v. subclavia. These are used when inserting a central venous catheter. 2 Again you delete acute adrenal insufficiency. Please read what this condition is (addisonian crisis). 3 Deleting therapy as suggested in Irwin and Rippe is odd when that is THE source of information in critically ill patients. Nomen Nescio 21:52, 28 March 2006 (UTC)

IABP - This is where the tip LIES, not where it is inserted

Adrenal insufficiency - in the wrong place - should be in treatmentPanthro

1 Acute adrenal insufficency causes shock and therapy consists of corticosteroids, since cortisol is lacking.

2 The IABP is inserted through the groin (a. femoralis) and the tip lies just caudal to the arcus aortae. Hence the name intra-aortic.

3 Therapy taken from Irwin and Rippe:

• Cardiogenic shock: Depending on the type of myocardal infarction one can infuse fluids or inotropica. Should that not suffice an Intra aortic balloon pump can be considered or a left ventricular assist device.
• Hypovolemic shock: In case of bleeding it is necessary to immediately control the bleeding and restore the victims blood volume by giving infusions of balanced salt solutions. Blood transufion are necessary for loss of large amounts of blood (e.g. greater than 20% of blood volume), but can be avoided in smaller and slower losses. Hypovolemic shock due to burns, diarrhea, vomiting, etc. is treated with infusions of electrolyte solutions that balance the nature of the fluid lost. Sodium is essential to keep the fluid infused in the extracellular and intravascular space (and prevent water intoxication and brain swelling). Metabolic acidosis (mainly due to lactic acid) accumulates as a result of poor delivery of oxygen to the tissues, and mirrors the severity of the shock. It is best treated by rapidly restoring intravascular volume and perfusion as above. Inotropic and vasoconstrictive drugs should be avoided, as they may interfere in the knowing that blood volume is returning to normal.
• Distributive shock: In sepsis the infection is treated and supportive care is given. Anaphylaxis is treated with adrenalin and corticosteroids. Adrenal insufficienty is treated with corticosteroids. In neurogenic shock because of vasodilation in the legs, one of the most suggested treatments is placing the patient in the trendelenburg position, thereby elevating the legs and shunting blood back from the periphery to the body's core. However, since bloodvessels are highly compliant, and expand as result of the increased volume locally, this technique does not work. More suitable would be the use of vasopressors.
• Obstructive shock: the only therapy consist of removing the obstruction.

4 Give me some time and I will insert references at all locations so you'll know where it is from. 5 Remeber you are a student nurse and it is not impossible you do not know everything. Nomen Nescio 22:18, 28 March 2006 (UTC)

Revert

Sorry to hinder your work yet again, but you are making several mistakes. 1 An Intra-aortic balloon pump[2] is inserted through the arteria femoralis and NOT the v. jugularis or v. subclavia. These are used when inserting a central venous catheter. 2 Again you delete acute adrenal insufficiency. Please read what this condition is (addisonian crisis). 3 Deleting therapy as suggested in Irwin and Rippe is odd when that is THE source of information in critically ill patients. Nomen Nescio 21:52, 28 March 2006 (UTC)

IABP - This is where the tip LIES, not where it is inserted

Adrenal insufficiency - in the wrong place - should be in treatmentPanthro

1 Acute adrenal insufficency causes shock and therapy consists of corticosteroids, since cortisol is lacking. Alot of things cause shock, is it necessary to mention them all? How prevalent is acute adrenal insufficiency in the formation of shock?Panthro

It is relatively common, read about it if you please. Nomen Nescio 22:50, 28 March 2006 (UTC)

More to the point, every patient on corticosteroid therapy that requires surgery or is acutely ill, should be seen by an internist to adjust the dosage. If not, adrenal insufficiency is a real possibility. The use of corticosteroid therapy and surgery are not uncommon things so this condition is not a rare complication. Nomen Nescio 19:45, 29 March 2006 (UTC)

2 The IABP is inserted through the groin (a. femoralis) and the tip lies just ventral to the arcus aortae. Hence the name intra-aortic. distal to the subclavian and ventral to the aortic arch is the same place.... Panthro

It is also ventral from the spine and distal from the larynx. No doctor uses the description you use. BTW the aorta descendens bends dorsal from the aorta ascendens, which makes "ventral to the aortic arch" incorrect. Nomen Nescio 22:50, 28 March 2006 (UTC)

3 Therapy taken from Irwin and Rippe:

• Cardiogenic shock: Depending on the type of myocardal infarction one can infuse fluids or inotropica. Should that not suffice an Intra aortic balloon pump can be considered or a left ventricular assist device.IN ARTCILE Panthro

But rewritten by you in a less accurate way. Nomen Nescio 22:50, 28 March 2006 (UTC)

• Hypovolemic shock: In case of bleeding it is necessary to immediately control the bleeding and restore the victims blood volume by giving infusions of balanced salt solutions.IN ARTCILEPanthro

But rewritten by you in a less accurate way. Nomen Nescio 22:50, 28 March 2006 (UTC)

Blood transufion are necessary for loss of large amounts of blood (e.g. greater than 20% of blood volume), but can be avoided in smaller and slower losses. Hypovolemic shock due to burns, diarrhea, vomiting, etc. is treated with infusions of electrolyte solutions that balance the nature of the fluid lost. IN ARTCILEPanthro

But rewritten by you in a less accurate way. Nomen Nescio 22:50, 28 March 2006 (UTC)

Sodium is essential to keep the fluid infused in the extracellular and intravascular space (and prevent water intoxication and brain swelling).IN ARTCILE - FURTHER EXPANSIONBut rewritten by you in a less accurate way. Nomen Nescio 22:50, 28 March 2006 (UTC)

Metabolic acidosis (mainly due to lactic acid) accumulates as a result of poor delivery of oxygen to the tissues, and mirrors the severity of the shock. IN ARTCILEPanthro

But rewritten by you in a less accurate way. Nomen Nescio 22:50, 28 March 2006 (UTC)

It is best treated by rapidly restoring intravascular volume and perfusion as above.IN ARTCILEPanthro

But rewritten by you in a less accurate way. Nomen Nescio 22:50, 28 March 2006 (UTC)

Inotropic and vasoconstrictive drugs should be avoided, as they may interfere in the knowing that blood volume is returning to normal. Distributive shock: In sepsis the infection is treated and supportive care is given.IN ARTCILEPanthro

But rewritten by you in a less accurate way. Nomen Nescio 22:50, 28 March 2006 (UTC)

Anaphylaxis is treated with adrenalin and corticosteroids.MOSTLY IN ARTCILEPanthro

But rewritten by you in a less accurate way. Nomen Nescio 22:50, 28 March 2006 (UTC)

Adrenal insufficienty is treated with corticosteroids. In neurogenic shock because of asodilation in the legs, one of the most suggested treatments is placing the patient in the trendelenburg position, thereby elevating the legs and shunting blood back from the periphery to the body's core. However, since bloodvessels are highly compliant, and expand as result of the increased volume locally, this technique does not work.WHY PUT THIS IN IF IT DOES NOT WORK???Panthro

Because many erroneously use Trendelenburg. Nomen Nescio 22:50, 28 March 2006 (UTC)

More suitable would be the use of vasopressors.IN ARTCILEPanthro

But rewritten by you in a less accurate way. Nomen Nescio 22:50, 28 March 2006 (UTC)

Obstructive shock: the only therapy consist of removing the obstruction.IN ARTCILEPanthro

But rewritten by you in a less accurate way. Nomen Nescio 22:50, 28 March 2006 (UTC)

So...

For the rather minor points above, you have reverted the whole article? I will gladly add them in..Panthro 22:37, 28 March 2006 (UTC)

The main reason is your deletion of parts of types of shock. Addisionian crisis is important, many doctors have missed the diagnosis and thought it was septic shock. Nomen Nescio 22:53, 28 March 2006 (UTC)

Third Opinion

Can't you add these parts in? I am not going to revert it anymore, In order to resolve this dispute I have asked for a third opinion Wikipedia:Third opinion

Mediation is always a good way to resolve disputes. Thank you. Nomen Nescio 22:54, 28 March 2006 (UTC)

Can either of you boil this down to a specific dispute? I see you're both reverting each other's changes, but I'm not quite sure what the source of your disagreement is. Fagstein 04:12, 29 March 2006 (UTC)

The following problems arise:

1 There are four types of shock used by physicians. An editor with insufficient medical knowledge thinks there are three, and first deleted the fourth[3] and now advocates it is suggested there are four types of shock.

2 Acute adrenal insufficiency causes what is called distributive shock. This editor not only repeatedly removed this condition, but falsely states that it does not result in shock.

• Have corrected this, part of endocrine shock.18:07, 29 March 2006 (UTC)

3 Then this editor completely rewrites medical therapies for these conditions into:[4]

• Cardiogenic shock: Intra-aortic balloon pump - Balloon placed in the distal left sub-clavian junction which assists in left ventricular ejection by increasing intra-aortic pressure. This assertion is incorrect, the balloon is placed between the aortic arch and renal arteries.
• Hypovolemic shock: In case of bleeding it is necessary to immediately control the bleeding and restore the victims blood volume by giving infusions of balanced salt solutions. Blood transufion are necessary for loss of large amounts of blood (e.g. greater than 20% of blood volume), but can be avoided in smaller and slower losses. Hypovolemic shock due to burns, diarrhea, vomiting, etc. is treated with infusions of electrolyte solutions that balance the nature of the fluid lost. Sodium is essential to keep the fluid infused in the extracellular and intravascular space (and prevent water intoxication and brain swelling). Metabolic acidosis (mainly due to lactic acid) accumulates as a result of poor delivery of oxygen to the tissues, and mirrors the severity of the shock. It is best treated by rapidly restoring intravascular volume and perfusion as above. Inotropic and vasoconstrictive drugs should be avoided, as they may interfere in the knowing that blood volume is returning to normal. is deleted and turned into a elaborate discussion.
• Distributive shock: In sepsis the infection is treated and supportive care is given. Anaphylaxis is treated with adrenalin and corticosteroids. Adrenal insufficienty is treated with corticosteroids. In neurogenic shock because of vasodilation in the legs, one of the most suggested treatments is placing the patient in the trendelenburg position, thereby elevating the legs and shunting blood back from the periphery to the body's core. However, since bloodvessels are highly compliant, and expand as result of the increased volume locally, this technique does not work. More suitable would be the use of vasopressors. This is deleted and replaced by less accurate therapies.

4 Although I suggested the original, and current , version was taken from medical textbooks, (I named them in the previous discussions and marked what is taken from them in the article) apparently that is insufficient cause for a student nurse which has not read these books to accept that he might be making incorrect edits based on physology and nursing textbooks. Nomen Nescio 13:33, 29 March 2006 (UTC)

Reread Irwin and Rippe, since I must confess my comments were based on memory and experience, and discovered a flaw in my argument. There are five types of shock. Therefore I have corrected that section to reflect what is presented in Irwin and Rippe (added note). Nomen Nescio 18:06, 29 March 2006 (UTC)

Clean slate

I have no problem with the content, it is the sentence structure, grammar and paragraphs that are my problem. Please, revert any mistakes I have made, but reverting the ENTIRE article is wrong in my opinion. And add the parts I have deleted, intentionally or not.

My medical knowledge is limited and I am the first to say that, but I think my English skills are quite good. Articles MUST be factually accurate, but they must also make sense.—Preceding unsigned comment added by Panthro (talk • contribs)

Let's start with a clean slate. Discussing what we think could be improved is indeed more constructive. Please, explain what part you would like to change and make a suggestion how you would change it.

You may have noticed I did use some of your edits and repaired your image. Nomen Nescio 20:49, 29 March 2006 (UTC)

---

The article is fine now, IMO, but we need a signs and symptoms for endocrine.

Oh and I have found a site which lists "Respiratory shock" - the credibility of which I am not sure...

Respiratory Shock is when there is not enough oxygen getting into the lungs. When this happens an insufficient amount of oxygen is carried on the red blood cells, and the tissues of the body fail to receive the amount of oxygen they require to survive. This will cause cyanosis (bluish tinge to the skin) to develop, initially in the hands and feet, then around the mouth and on the face, then if not corrected, centrally on the body. Respiratory shock can be caused by trauma, but the most common culprits are: airway obstructions, asthma, congestive heart failure (CHF), pulmonary edema (PE), other diseases of the lungs like Chronic Obstructive Pulmonary Disease (COPD), and inhalation of gases other than oxygen, i.e. carbon monoxide or nitrous oxide that has not been diluted with O2. Some signs and symptoms to look for are cool, clammy skin, pale or cyanotic color, use of accessory muscles to breath, inspiratory stridor (sounds like a high pitched crowing sound when the patient inhales), wheezing, rhonchi, or rales. —Preceding unsigned comment added by Panthro (talk • contribs)

Never heard of it, but it does fit the definition: mismatch between oxygen required by and oxygen delivered to tissues. What site is it, can you show the link?

BTW, don't forget to sign your posts here, otherwise nobody knows who said what. Four tildes. Nomen Nescio 21:35, 29 March 2006 (UTC)

---

http://www.alpharubicon.com/med/shockpalehorse.htm Panthro

• Although it has some good points it surely has more amateuristic qualities and we must not use it. Nomen Nescio 21:47, 29 March 2006 (UTC)

Agreed. Panthro 22:00, 29 March 2006 (UTC)

Higher up this page I have also explained the why distributive shock has relative hypovolemia, you may want to read. Nomen Nescio 22:04, 29 March 2006 (UTC

Dead Horse?

HI - I don't think "Endocrine Shock" should have its own heading. Its not a widely used term in clinical practice and the types of shock described therein can be reclassified into the the more recognised categories. For instance - hypo and hyper thyroidism cause shock through thier effects on the heart - cardiogenic. Likewise lack of cortisol causes a form of distributive shock. Any thoughts?SkinnyB 22:32, 7 June 2006 (UTC)

Although you are correct that it is not well-known, please consider the fact that this is the classification offered by Irwin and Rippe. Since that Textbook is to intensive care medicine what the Harrison is to internal medicine I think we should adopt their view.Nomen Nescio^{Gnothi seauton} 11:09, 8 June 2006 (UTC)

Simplify?

Is it possible to simplify part of the introduction so that laymen like me could actually understand what shock is? I don't advocate dumbing down the entire entry, but a couple sentences written so that someone with limited knowledge of physiology could understand the concept would be nice.

Infobox

Disease Infobox restored. I assume it was removed along with vandalism on 6/10. The infobox template provides a compact set of references and links - it may not be self-evident yet but is being refined - see Template_talk:Infobox_Disease#Suggestion Finavon 20:54, 9 October 2006 (UTC)

References & Notes

Several of the "footnotes" (often to a full paragraph) also appear in the references list. Can they be combined without losing the ability to support individual statements? Finavon 23:14, 9 October 2006 (UTC)

Unclear

Someone needs to edit this page so a laymen can understand it. I want to understand what shock is, medically, but it needs to be explained to me. There is too much assumed knowledge on this. It's an encyclopedia - anyone should be able to understand it.

• Is it possible to elaborate on what part and which words you do not understand?Nomen Nescio^{Gnothi seauton} 13:24, 13 August 2007 (UTC)

I agree with whoever wrote the first point here. I was curious about what exactly it means when somebody goes into shock, and I just wanted a quick explanation. I came here and can't even read this, as I have no medical background, and I don't really care to first spend hours studying just to get a basic idea of it. I found this on the NIH website: "Shock is a life-threatening condition that occurs when the body is not getting enough blood flow. This can damage multiple organs. Shock requires IMMEDIATE medical treatment and can get worse very rapidly." That's all I wanted to know; is it possible to say something similar (without copying, of course) at the top of this page for us laymen, while leaving the rest intact, so we don't have to first learn what these all mean: adenosine triphosphate, hypoxia, pyruvic acid, metabolic acidosis, baroreceptors, noradrenaline, Renin-angiotensin, arginine vasopressin, renal system, Renin-angiotensin axis, homeostatic, compensatory mechanisms, perfusion of the cells, anaerobic metabolism, arteriolar, precapillary sphincters, hydrostatic pressure, micro-circulation, reduced perfusion? Jeffcogs 01:16, 7 September 2007 (UTC)

I have updated the introduction here (although not got in to the body of the text as yet). You were all quite correct, I imagine it was quite difficult for a lay reader. Have a look at the new intro, and see if you think its pitched at the right level. Owain.davies 07:54, 9 September 2007 (UTC)

For me, this new intro is much better, providing a good intro for those of us who aren't medical people. Thanks! Jeffcogs 14:40, 14 September 2007 (UTC)

GA review

GA review (see here for criteria)

1. It is reasonably well written.

   a (prose):A bit wordy and over-complicated. Try to use simple sentences in the active voice. Just some examples from the first section:

   "The process of removing these compounds from the cells by the liver requires oxygen, which is absent." would be better as "These compounds are normally removed from the cells by the liver, but this requires oxygen so the liver cannot do this during hypoxia."

   "This stage is characterised by the body employing physiological mechanisms, including neural, hormonal and bio-chemical mechanisms in an attempt to reverse the condition." would be better as "During this stage the body employs physiological mechanisms, including neural, hormonal and biochemical changes in attempts to reverse the condition."

   "As a result of the acidosis, the person will begin to hyperventilate in order to rid the body of carbon dioxide (CO2). CO2 indirectly acts to acidify the blood and by removing it the body is attempting to raise the pH of the blood." would be better as "Acidosis causes the person to hyperventilate, which removes carbon dioxide (CO2) from their blood. As this gas acidifies the blood by producing carbonic acid, hyperventilation is an attempt by the body to raise the pH of the blood back to the normal value."

   Introduction to the section on "Stages of shock" needs to list the stages and give a brief overview, so the reader isn't plunged into the details if they are skimming the article.

   b (MoS):

   No sections on Diagnosis, Prevention or History (see MedMOS). I realise that there are a very broad set of causes, so for prevention it would probably be OK to just state at the start of the section on types of shock that prevention depends on treating the particular cause of the condition (unless there are general preventative measures). The section on "Signs and symptoms" could be renamed "Symptoms and diagnosis".

2. It is factually accurate and verifiable.

   a (statements):

   The discussion of cellular pathology in "Stages of shock - Initial" is a bit confused. Is it the lack of oxygen that causes disruption of the plasma membrane, or the lack of ATP? Simlarly, it isn't the fact that cells become more permeable that causes them to switch to anaerobic respiration, it is the lack of oxygen. Causes and effects are a bit confused in this section.

   The liver doesn't remove compounds from cells, it removes them from the circulation.

   "Renin-angiotensin axis is activated" - What is the "axis"?

   "a fifth form of shock has been introduced" - might be better to say a "fifth classification", so it doesn't sound like doctors are promoting a new form of illness! :)

   b (citations to reliable sources):

   Many sections have no citations. A reader should be able to check where a statement comes from, and the citations in the text lack page numbers.

   c (OR):

   No obvious OR I can spot, but few citations so it takes specialised knowledge to say this.

3. It is broad in its coverage.

   a (major aspects):

   Yes, although a history section would be a good addition.

   b (focused):

   Yes, good.

4. 4. It follows the neutral point of view policy.

   Fair representation without bias:

   Fine.

5. 5. It is stable.

   No edit wars etc.:

   None.

6. 6. It is illustrated by images, where possible and appropriate.

   a (images are tagged and non-free images have fair use rationales):

   b (appropriate use with suitable captions):

   The shock therapy image would be much better as a table or list, there is no need for a figure only containing text.

7. 7. Overall:

   Fail I'm afraid. It's got all the information for a GA, but particularly with the citation problems and the rather dense prose I can't pass this at the moment. Tim Vickers (talk) 16:49, 6 April 2008 (UTC)

loss of consciousness

HI i would like to know if there is loss of consciousness during shockEl thunder (talk) 12:03, 24 June 2008 (UTC)

All forms of shock will lead to reduced and then loss of conciousness in latter stages. OwainDavies ^(about)_(talk) edited at 19:44, 24 June 2008 (UTC)

Treatment Section

Having just completed a class on basic first aid, I'm aware that while waiting for EMS to arrive, it's recommended that a shock victim's legs be elevated 12-18 inches (victim is lying on back). Should this information be added to the Treatment section? --Spiff666 (talk) 18:59, 5 November 2010 (UTC)

I have a question about the treatment section. In this section, it mentions a debate between stay and stabilize or load and go. As an EMS provider in Canada, I had no knowledge of any debate. As far as I know, the only real treatment is to get the patient into an operating room as quickly as possible. The only other prehospital treatment I know of is two large bore IVs and oxygen administration. The only long term fix is to get them to an operating room. If anyone can better inform me of the debate, I would really appreciate it.

I won't edit the article for a bit, but I would really appreciate some reference to the debate, or else I think the sentence should go away. Thanks a lot. Nickers (talk) 01:46, 17 October 2008 (UTC)

This is a strange bit of logic about the "debate" between stay and stabilize or load and go: "respecting the golden hour. If surgery is required, it should be performed within the first hour to maximise the patient's chance of survival." If one actually reads the article on the Golden Hour, it emphasizes doubt on the validity of the entire concept. I suspect the writer didn't actually read the Wikipedia Golden hour (medicine) article, and has not kept up-to-date in the field either. Without references or citations, it sounds like a "debate around the water cooler" rather than policy debate. I vote for deletion. Cuvtixo (talk) 01:41, 21 October 2008 (UTC)

Based on the lack of real supporting evidence, or dissent from other users, I will edit the article accordingly. Nickers (talk) 18:56, 28 October 2008 (UTC)

Endocrine

Not an accepted form of shock. Hyperthyroid is cardiogenic as it works via cardiomyopathy and Addisonian crisis as a type of distribution shock.--Doc James (talk · contribs · email) 21:24, 18 April 2009 (UTC)

I have a copy of Irwin and it does not once comment on endocrine shock. Thus we have a serious problems. Please add page numbers for this ref. Uptodate does not recognize this either. Looks like OR?--Doc James (talk · contribs · email) 21:32, 18 April 2009 (UTC)

References

I've added William R. Emerson, that is one of his works. Here it is listed [5].

Austerlitz -- 88.75.203.240 (talk) 08:38, 16 July 2009 (UTC)

Woosh.

This article was basically illegible to two reasonably non-simian laypeople. It piles on terminology from the first paragraph.

How about opening with a straightforward definition aimed at someone without a medical degree? —Preceding unsigned comment added by 98.108.26.187 (talk) 00:29, 27 June 2010 (UTC)

Edit: The NIH got it right - http://www.nlm.nih.gov/medlineplus/ency/article/000039.htm - I now understand what the word "shock" means, how to possibly recognize it, and what to do if I suspect someone has it. Seems like the sort of information a Wikipedia article on shock ought to make highly accessible. —Preceding unsigned comment added by 98.108.26.187 (talk) 00:38, 27 June 2010 (UTC)

Yup, I'm going to change 'tecidual' to tissue, mainly because it took me a good couple minutes to figure that out, and I should be familiar with the terminaology. BertieB (talk) 00:31, 30 September 2010 (UTC)

Cushing's?

I know I'm merely a humble EMT, but I've never heard the association of the Cushing's reflex/ Cushing's triad with anything other than increased intracranial pressure--and certainly not with shock. Moreover, the article currently is phrased so that it sounds as if the adrenaline response (and subsequent increase in blood pressure and heart rate) are the Cushing's reflex/triad while the true Cushing's triad is, in fact, traditionally marked by bradycardia (although, admittedly also by increased systolic pressure). Can anyone validate this? Is there even any reason for mention of the Cushing's reflex in relation to shock? -3loodlust (talk) 01:28, 15 November 2010 (UTC)

I'm a medical student actually and I read about shock in some of the books. In this book "Textbook of Medical Physiology" written by Dr. G.K.Pal published by Ahuja Publishing House, it did mentioned at section IX, page 677 that Cushing reflex is activated during rapid compensatory reaction in order to increase vasoconstriction and cardiac output. So, this is what I found. Cerevisae (talk) 17:50, 2 January 2011 (UTC)

I'm a second year medical student and this Cushing's reflex is in none of my textbooks. It sounds like rubbish, and has made me suspicious of the rest of the article. Someone should remove it, or find an extremely good reference. Makes no physiological sense to me.— Preceding unsigned comment added by 129.67.156.208 (talk) 14:32, 17 February 2011 (UTC)

I'm going to second the question of Cushing's in relation to regular systemic shock, I have only read it in relation to increased ICP. For the 3rd, unsigned comment, Cushing's reaction is a known sympathetic nervous reaction to increased ICP causing an extreme and rapid rise in arterial pressure to compensate for a compressed artery in the brain, like Korotkoff sounds. My physiology book, Guyton's 11th, lists it after mentioning the extreme sympathetic nervous response to cerebral ischemia from any cause, which, I suppose would occur as well in circulatory shock. I'm not sure if bradycardia occurs often in circulatory shock, it seems I hear tachycardia more commonly associated with this. However, Cushing's reaction and Cushing's triad could hold a distinction. In my all-to-brief studies of these subjects, I have not seen it associated with circulatory shock. Bloomingdedalus (talk) 22:46, 22 June 2011 (UTC)

Simplification for non-specialists

I embedded definitions of the relevant medical terms early in the article. I think the very first sentence of the article should be simple enough to effectively define shock without using a word (perfusion) unknown to a layperson.

Did the same with rapid heartbeat/low blood pressure. No need for non-specialist readers to have to click on an entire new article to get a meaning that can be communicated in two words. — Preceding unsigned comment added by 67.169.117.19 (talk) 03:32, 28 May 2011 (UTC)

Not a B

This is not a B article, I am down-grading it. There are too many uncited statements, poor reference style in some of the cited statements. There are too many lists which can be converted to prose or tables. Just too many problems in general. Bloomingdedalus (talk) 22:46, 22 June 2011 (UTC)

References

• Levinson, AT (2011 Apr). "Reducing mortality in severe sepsis and septic shock". Seminars in respiratory and critical care medicine. 32 (2): 195–205. PMID 21506056. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)Doc James (talk · contribs · email) 14:18, 30 August 2011 (UTC)

Recent edit

The edits of the past days, transforming the subtypes as discussed in numerous textbooks, into some sort of DD is a mystery to me. The most relevant sources have been eliminated (Rippe, FCCS), from what used to be the best part of this article, which has proven that improvement was not the principal goal. Was there a compelling reason to rewrite that paragraph to no longer reflect the sources? Or, was the fact the sources were not part of the decision the cause of removing them alltogether?--- Nomen Nescio ^{Gnothi seauton}_{contributions} 14:36, 22 September 2011 (UTC)

• Just noticed that in both sepsis and SIRS there appears the same aversion to the use of the more recent RS, i.e. FCCS, Rippe. Is there a compelling reason to not use what intensivists consider their goto textbook?--- Nomen Nescio ^{Gnothi seauton}_{contributions} 14:44, 22 September 2011 (UTC)

The source Rippe is from 2003. Updating per WP:MEDRS. Another reason for the rewrite is we are trying to write in an encyclopedic format (which means in prose rather than in lists). The Rippe text looks good just should use a newer version. BTW references to it have not been removed by me (except the one in the lead)... Doc James (talk · contribs · email) 02:20, 9 October 2011 (UTC)

MDF

Should we include a link to this article somewhere? Apparently it has a significant role to play in shock. http://en.wikipedia.org/wiki/Myocardial_depressant_factor Td1wk (talk) 21:32, 3 May 2012 (UTC)

First Aid - The Basics for Ordinary People

Please could we have a totally simple section in the article on First Aid applications, basically: (1) what causes it, (2) how to recognise the condition, (3) how to give basic treatment while waiting for a doctor or ambulance ? Thanks. Darkman101 (talk) 20:59, 19 August 2012 (UTC)

That sounds like it would be WP:HOWTO, which isn't permitted. That is in the Wikibook on First Aid. OwainDavies ^(about)_(talk) edited at 12:23, 20 August 2012 (UTC)

In a recent post to the end of the lead section which I think is fine but thought it might be better in the Management section under a heading of First Aid

To my surprise I found that there is a section on the Shock Talk page about First Aid They mention that similar comments might be a be WP:HOWTO which isn't permitted. In other words Wikipedia is not a instruction manual or How To.

I hope this is helpful. If it is an issue maybe the comments can be rewritten to comply and maybe left where they are. @JenOttawa: Reknihtdivad (talk) 16:51, 23 October 2024 (UTC)

@Reknihtdivad: thank you for the note. I had not checked the talk page before adding my idea for an improvement so I was not unaware of this. I agree that wikipedia is not a medical manual but also like to make clear language (people without a medical background) improvements and that was my idea here. If someone disagrees with what I added from my secondary source, please do feel free to edit or modify! I just found that the lead was very medically 'how-to' inclined so that was my idea to try to improve. Thank you again for the note! JenOttawa (talk) 17:36, 23 October 2024 (UTC)

I hope my note was helpful to you.

Happy editing. Reknihtdivad (talk) 20:23, 23 October 2024 (UTC)

Thank you again and happy editing to you too :) JenOttawa (talk) 21:34, 23 October 2024 (UTC)

Fluids in child shock questioned

The Fluids section says that "Aggressive intravenous fluids are recommended". A BBC News online story today claims that Child shock guidelines 'are deadly', citing a study in N Engl J Med 2011. The study found that bolus-fluid increased the risk of death, and "could not find any subgroup in which fluid resuscitation was beneficial". Should this be mentioned in the fluids section? I don't have the expertise. - Pointillist (talk) 08:56, 14 January 2014 (UTC)

Suggestions for Improvement

Nice elucidation of the the positive feedback effect of circulatory shock. Consider adding briefly to the lead physical signs and symptoms (i.e. cool and clammy skin), the stages of shock from pre-shock to end organ failure, and the 3 (or 4) types of shock. — Preceding unsigned comment added by Dfhicks12 (talk • contribs) 00:16, 25 February 2015 (UTC)

Hemorrhagic shock NEJM

doi:10.1056/NEJMra1705649 JFW | T@lk 09:31, 26 January 2018 (UTC)

Text

Which ref says "prolonged, inadequate blood pressure" as the definition?

Why was pulse pressure removed? One of the first findings in fact. Doc James (talk · contribs · email) 12:36, 22 May 2019 (UTC)

This is strange "Shock can still be diagnosed by measuring vital signs. As shock develops, the first vital sign to change is skin temperature and color; the patient will become pale and cool."

Many people with shock have a fever and are warm. Some become flushed. Doc James (talk · contribs · email) 12:37, 22 May 2019 (UTC)

Upgrading the page

Hello everyone,

I am a 4th year medical student. As part of a course I am enrolled in, I am hoping to make several changes and modifications to this article on shock - with the end goal of improving readability, adding content to several sections, and embellishing on the several bullet points located throughout the article. I am also hoping to update many of the literature references in order to make sure that the article conforms to the latest guidelines and recommendations. Unfortunately, due to the nature of the topic of this article, some medical terminology will have to be used - however, I will link to the relevant topics and simplify as needed. With luck, I am hoping to get the page promoted to B-Class.

If there are any suggestions, please let me know. Keo1274 (talk) 04:42, 4 November 2019 (UTC)

Here's a good recent source on therapeutics: doi:10.1007/s00134-019-05801-z JFW | T@lk 15:19, 5 November 2019 (UTC)

Circulatory Shock Peer Review

I really like the infobox on the top right side of the page. I will utilize this to better my Hypoalbuminemia page specifically because it was incomplete and partially incorrect for my article.

The lead gives a great overview of the article and does it in very simple, plain language with medicalization as appropriate. I feel like if this was the only part of the page that I read, I would have an appropriate familiarization with the topic.

The “Signs and symptoms” section could use some improvement. For one, I think the “Hemorrhage classes” table would be more appropriately located within the diagnosis section of the article. I understand the reasoning of putting it in this section because this is where you talk about changes in heart rate and BP being signs and symptoms of shock, but assigning a class of shock to a patient is a diagnostic process. In addition, it is odd to break up the “Signs and symptoms” into subtypes and then not include obstructive shock. I think that two options to overcome this issue would be to either add obstructive shock and better each subtype specifically, or to write your own integrative section that uses the differentiating features to better show how the signs and symptoms can be used to tell the difference between the types of shock. I appreciate having the bullets for each sign and symptom. I think this is an effective way to organize something that is mostly in lists. Two organizational minutiae to fix would be to get rid of the septic shock subsection within distributive shock (too much organizing) and to make bullet points for distributive shock instead of having this be a narrative.

The “Cause” section is well-organized and gives appropriate amounts of information and resources to each of the types of shock, including endocrine shock (which hasn’t yet been mentioned in the article). Reading this after the “Signs and symptoms” section is a little odd and I would consider switching them especially given the focus of the “Signs and symptoms” section on differentiating features. Further, given that you go into such detail here for the four different types, I would especially consider writing an integrative “Signs and symptoms” section instead of a section based on the different types. As for minutiae, I would suggest limiting the extensive quotations within the septic shock bullet point under distributive shock.

The “Pathophysiology section” is a really well-done one. I have almost no critiques. On the one hand, this section is particularly medicalized and uses a number of terms and concepts that would be unknown to the lay reader, but on the other hand, this is a section that is probably purposefully targeted towards medical students and other providers instead of patients and their families. You could consider optimizing this section in terms of language (it is a grade 13 on the Hemingway App). Also love the figure. Minutiae: citation needed for all information provided for the compensatory phase of shock.

The “Diagnosis” section does not have a real purpose as the article is currently written. Instead of being a section that talks about how you can determine whether or not a patient is in shock when they show up in your emergency room or on your floor, it talks about what tests you would use on a patient that is suspected to be in shock. I would revamp this section by talking about ways in which shock can be first identified (including SIRS criteria), ways you can differentiate between the different causes (briefly since this is a whole section), diagnosing the different classes of shock (based on the table now in “Signs and symptoms”), and considering adding a differential diagnosis subsection.

The “Management” section is well-organized and I appreciate how the different parts are organized. This is especially particular for this article but I plan to use similar concepts for my own article. I think the “Mechanical support” subsection needs to be fleshed out a bit, but the other sections look great as is.

Finally, the “Epidemiology”, “Prognosis”, and “History” sections are limited but do provide appropriate information. These could be fun for you to fill out but personally I don’t think that they are so necessary for either patients or providers viewing the page.

Overall, I think this is a great article. I can totally see why it was nominated (in 2008!) to be considered a “Great Article”, but I can also see why it didn’t meet some of those criteria. I think editing the article with a focus on accessibility and organization could really increase the impact of the article and its utilization by patients and providers. Specifically, I think that all of the framework is there to make this a complete article, but needs focus within those sections to make it more effective. I would focus on the specific changes mentioned above and expand other sections as you see fit given your interests. Well done and I look forward to seeing how this looks at the end of the week!

Naharris2 (talk) 16:58, 15 November 2019 (UTC)

Symptoms

All forms of shock have a group of basic symptoms. In my opinion those should be discussed under the main "signs and symptoms" heading with subsequent sections only discussing the symptoms specific or special to that form. Doc James (talk · contribs · email) 08:07, 16 November 2019 (UTC)

Agree. JFW | T@lk 21:18, 16 November 2019 (UTC)

Redirection for hypoperfusion

Hypoperfusion is currently redirected to shock. However, I personally think ischemia is a better place for the redirection of hypoperfusion. How do you people think? --Envisaging tier (talk) 05:31, 24 December 2019 (UTC)

@Envisaging tier: None of those terms are completely identical. Hypoperfusion doesn't always mean shock but it also doesn't mean ischaemia in the strictest sense... JFW | T@lk 13:05, 26 December 2019 (UTC)

Jfdwolff Thank you for the reply. Some Wikipedians also discussed the matter at Talk:hypoperfusion. You're very welcomed to join! --Envisaging tier (talk) 16:00, 26 December 2019 (UTC)

"Shock(circulatory)" listed at Redirects for discussion

An editor has identified a potential problem with the redirect Shock(circulatory) and has thus listed it for discussion. This discussion will occur at Wikipedia:Redirects for discussion/Log/2022 April 22#Shock(circulatory) until a consensus is reached, and readers of this page are welcome to contribute to the discussion. Steel1943 (talk) 06:01, 22 April 2022 (UTC)

Rename with natural title

I suggest renaming the article from Shock (circulatory) to Circulatory shock.

Per WP:TITLEDAB, natural disambiguation is preferred over parenthetical disambiguation. The full phrase “circulatory shock” seems to be common enough to be a good title for this article. 2600:8802:6900:62:0:0:0:1008 (talk) 03:19, 2 July 2022 (UTC)

Conflicting info

The Low Volume subsection says that is the most common type of shock, but the Epidemiology section says septic shock is 3 times more common. Seananony (talk) 04:29, 21 September 2024 (UTC)