[Major points]

1. Hypovolemic shock is caused by insufficient blood volume in the blood vessels.
2. Common symptoms of shock include pallor, lower blood pressure, and difficulty breathing etc.
3. Please go to the hospital promptly if you suspect you have symptoms of shock.

I. What is Shock?

Shock occurs when there is insufficient fluid or blood in the vessels, resulting in inadequate blood flow to vital organs and a drop in blood pressure.

II. What are the Causes of Shock?

Five common causes of shock are:

1. Hypovolemic shock: Caused by a lack of blood volume in the blood vessels, which triggers lower blood pressure. Such as massive bleeding caused by a tremendous injury, or gastrointestinal bleeding.
2. Cardiogenic shock: Caused by insufficient blood volume, resulting in a shortage of supply from the heart to pump enough blood volume to the whole body, which causes lower blood pressure. Such as severe myocardial infarction and arrhythmia.
3. Septic shock: Caused by infection of bacteria, virus as such that it triggers systemic inflammation resulting in vascular distension and lower blood pressure.
4. Anaphylactic shock: Caused by an allergic substance. Such as food, medicines, articles, or being bitten by bees, resulting in hard breathing, lower blood pressure, etc. An urgent, severe, and inflamed reaction.
5. Neurogenic shock: Caused by central nervous system injury as a result of a slow heartbeat and lower blood pressure. Such as spinal cord trauma or spinal anesthesia.

III. Common symptoms of shock:

Symptoms of pallor, clammy skin, dizziness, weakness, or unconsciousness can be easily found in the early stage. Without proper treatments, hard breathing, lower blood pressure, rapid heartbeat, decreased urine, unconsciousness, organ failure, and even death can be caused.  

If you experience any of the above symptoms, it does not necessarily mean that you are in shock; please go to the nearest hospital immediately.

IV. Common Treatment:

When shock occurs, medical staff will identify the cause and take immediate action.

1. Hypovolemic shock:
   1. Decreased blood pressure: When blood pressure drops, the head-down feet-high position will increase the heart's blood volume. With an intravenous fluid supply, the use of medicine to raise blood pressure will keep the systolic pressure over 90mmhg.
   2. Bleeding control: Blood transfusion, use of hemostatic medications or invasive treatments after evaluation by physicians, such as angiographic embolization to stop bleeding, surgical treatment, etc.
2. Cardiogenic shock:
   1. Medication treatment: Inotropic agents can be used to improve cardiac contractile function.
   2. Interventional treatment: After physician evaluation, surgery or mechanical support devices such as an intra-aortic balloon pump (IABP) or extracorporeal membrane oxygenation (ECMO) may be recommended to assist in treatment.
3. Septic shock:
   1. Infection control: To identify the cause/source of infection, bacterial cultures will be collected first, and remove potential sources of infection after, for example, the peritoneal dialysis catheter will be removed before administering antibiotic therapy.
   2. Inflammation Control: Use antihistamines or steroids to reduce allergic inflammation.
4. Anaphylactic shock:An epinephrine injection should be given right away. Steroids and antihistamines can be used to help reduce the allergic reaction. If breathing becomes difficult, oxygen therapy and bronchodilators may be provided to help you breathe more comfortably.
5. Neurogenic shock:
   1. When blood pressure decreases, start with IV fluid infusion and use medications to raise blood pressure.
   2. Stabilizing spinal cord injury: For patients with neurological damage, surgery may be required after physician evaluation to prevent further injury.

V. Principles of Shock Care:

1. To maintain smooth breathing, oxygen will be used when symptoms are mild. Intubate with an endotracheal tube and connect to the mechanical ventilator when symptoms are severe.
2. When the condition is severe, the patient will be sent to the intensive care unit and be monitored closely by physiological devices to measure blood pressure, heartbeat, and breathing changes.

References

1. Chang, K.Y., Lin, M.H. & Lo, S.C. (2024). Anaphylactic transfusion reaction caused by anhaptoglobinemia. Taiwan Hemovigilance Network Annual Report, 35-38.https://doi.org/10.30029/THNAR.202407_2023.0008
2. Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., McIntyre, L., Ostermann, M., Prescott, H. C., Schorr, C., Simpson, S., Wiersinga, W. J., Alshamsi, F., Angus, D. C., Arabi, Y., Azevedo, L., Beale, R., Beilman, G., … Levy, M. (2021). Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Medicine, 47(11), 1181-1247. https://doi.org/10.1007/s00134-021-06506-y
3. Huang, S.F., & Wang, Y.C. (2022). Definition and Management of Sepsis and Septic Shock: A Short Review. Journal of Internal Medicine of Taiwan, 33(4), 287-297. https://doi.org/10.6314/JIMT.202208_33(4).04
4. National Health Insurance Administration, Ministry of Health and Welfare, Taiwan, ROC. (n.d.). Shock. Retrieved August 17, 2023 from https://www.nhi.gov.tw/Content_List.aspx?n=A9C998BB2E1BAA57&topn=5FE8C9FEAE863B46