**10. Anaphylactic shock**

Immunoglobulin E mediated response due to insect stings, food, and drugs. Cardinal feature is circulatory collapse associated with bronchospasm and increase airway resistance. It can be associated with skin manifestations of wheals and hyperemia. There can also be vomiting and

in catecholamine production resulting in manifestation of tachycardia, when in shock. Elderly patients are mostly on multiple medications. Beta blockers worsen hypotension caused by trauma and also mask the tachycardia, which is an early sign of shock. Volume resuscitation must be strictly monitored as most patients have decreased cardiac contractility and can eas-

Shock

37

http://dx.doi.org/10.5772/intechopen.76242

They may not manifest any signs of shock due to their unusual compensatory mechanism,

Pregnant patients would present with signs of shock only after huge volume of blood is lost,

Shock is a state of global tissue hypoperfusion. After initial resuscitation, detailed physical examination is important to determine the cause of shock. Patients in shock have to be kept on monitored bed. Urine output and central venous pressure would need to be monitored in

In trauma patients, hypovolemia is the main reason for shock. Control of hemorrhage and blood replacement are necessary. Hypovolemia can also develop due to gastroenteritis, heat stroke, febrile illness, etc. Septic shock needs early administration of antibiotics, after drawing a full septic workup. Cardiogenic shock needs to be treated meticulously and monitored closely. Inotropes and fluids have to be administered, cautiously. Neurogenic shock needs good vasopressor support. Obstructive shock whether it is tension pneumothorax or pericardial tamponade, both, need decompression. Pulmonary embolism needs to be treated with anticoagulants. Anaphylactic shock can be managed by administration of parenteral epineph-

Management of shock is often complicated especially in extremes of age, pregnancy, and

ily go into volume overload [2].

despite significant amount of blood loss [2].

due to their physiological maternal hypervolemia [2].

rine, crystalloids, steroids, and antihistamines [3].

Address all correspondence to: ranajaffer1979@yahoo.com

[1] Tintinalli's Emergency Medicine. A Comprehensive Study Guide. 8th ed

Hamad Medical Corporation (HMC), Doha, Qatar

patients with multiple comorbidities [2].

**11.2. Athletes**

**11.3. Pregnancy**

**12. Conclusion**

such patients [2].

**Author details**

**References**

Rana Jaffer Hamed Hussein

**Figure 6.** Anaphylaxis management algorithm [8].

diarrhea, too. Management includes stabilizing the patient; maintaining the airway patency; effective breathing; prompt use of epinephrine, fluid resuscitation, parenteral steroids, and antihistamine; and the use of bronchodilators, if necessary [3] (**Figure 6**).
