Shock stages and clinical manifestations

Patients who are in shock will generally stay in the hospital until they wake up, because only when they are awake can we better understand their condition. During hospitalization, the primary caregiver for patients with shock may be the hospital's nursing staff. In order to better care for patients with shock, medical staff need to be very clear about the care of shock. So what are the stages and clinical manifestations of shock?

According to the pathophysiological process of shock, it is usually divided into three clinical stages.

1. The early stage of shock is the compensatory shock stage. The patient is conscious, irritable, fearful, nervous, nauseous and vomiting. Pale face and skin, cyanosis of lips and nail beds, cold sweat, decreased urine output, rapid pulse, normal or low systolic blood pressure, slightly elevated diastolic blood pressure, and decreased pulse pressure difference.

2. The middle stage of physical stress is decompensated shock. During this stage, patients have a dull expression, slow reaction, or confusion, weakness, cold and clammy skin, cyanosis of the extremities, mottled skin, a rapid pulse, blood pressure dropped to 60-80 mmHg, pulse pressure difference <20 mmHg, superficial vein collapse, and urine volume <20 ml/h. If the condition worsens further, the patient may fall into a coma, have rapid breathing, systolic blood pressure below 60 mmHg or no urine.

3. The late stage of shock is irreversible shock. DIC and MODS may occur during this stage. With continued severe tissue perfusion deficiency, cell function damage and even microcirculation failure and death may occur.

Shock is a syndrome in which the body is attacked by strong pathogenic factors, resulting in a sharp drop in effective circulating blood volume, widespread, continuous and significant reduction in tissue blood perfusion, poor systemic microcirculation function and serious disorders of important organs. At this time, the body's functions lose compensation, tissues are ischemic and hypoxic, and neuro-humoral factors are out of balance. Its main characteristics are: insufficient microcirculatory perfusion in important organ tissues, metabolic disorders and functional disorders of various systems throughout the body. In short, shock is the body's response to a decrease in effective circulating blood volume. It is a pathological process of metabolic and cellular damage caused by insufficient tissue perfusion.

A variety of neurohumoral factors are involved in the occurrence and development of shock. The so-called effective circulating blood volume refers to the amount of blood circulating through the cardiovascular system per unit time. Effective circulating blood volume depends on three factors: adequate blood volume, effective cardiac output and perfect peripheral vascular tension. When the change of any one of these factors exceeds the compensation limit of the human body, it can lead to a sharp drop in effective circulating blood volume, causing insufficient oxygenated blood perfusion to tissues and organs throughout the body and cellular hypoxia, resulting in shock. In the occurrence and development of shock, the above three factors are often involved and influence each other.