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This article was the subject of a Wiki Education Foundation-supported course assignment, between 29 October 2019 and 6 December 2019. Further details are available
on the course page. Student editor(s):
Keo1274. Peer reviewers:
Naharris2.
Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT ( talk) 09:15, 17 January 2022 (UTC)
This article needs to mention psychological shock. -- Tarquin
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)
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)
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)
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)
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)
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)
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)
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)
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:
2 In intensive care medicine doctors use these references
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)
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)
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)
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:
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)
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)
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
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
3 Therapy taken from Irwin and Rippe:
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 ARTCILE Panthro
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 ARTCILE Panthro
It is best treated by rapidly restoring intravascular volume and perfusion as above.IN ARTCILE Panthro
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 ARTCILE Panthro
Anaphylaxis is treated with adrenalin and corticosteroids.MOSTLY IN ARTCILE Panthro
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
More suitable would be the use of vasopressors.IN ARTCILE Panthro
Obstructive shock: the only therapy consist of removing the obstruction.IN ARTCILE Panthro
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)
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
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.
3 Then this editor completely rewrites medical therapies for these conditions into: [4]
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)
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)
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)
http://www.alpharubicon.com/med/shockpalehorse.htm Panthro
Agreed. Panthro 22:00, 29 March 2006 (UTC)
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)
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.
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)
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)
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.
HI i would like to know if there is loss of consciousness during shock El thunder ( talk) 12:03, 24 June 2008 (UTC)
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)
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've added William R. Emerson, that is one of his works. Here it is listed [5].
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)
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)
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)
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)
{{
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)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)
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)
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)
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)
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)
doi:10.1056/NEJMra1705649 JFW | T@lk 09:31, 26 January 2018 (UTC)
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)
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)
Naharris2 ( talk) 16:58, 15 November 2019 (UTC)
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)
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)
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)
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)
![]() | Shock (circulatory) was a Natural sciences good articles nominee, but did not meet the good article criteria at the time. There may be suggestions below for improving the article. Once these issues have been addressed, the article can be renominated. Editors may also seek a reassessment of the decision if they believe there was a mistake. | |||||||||
|
![]() | This ![]() It is of interest to the following WikiProjects: | ||||||||||||||||||||
|
![]() | Ideal sources for Wikipedia's health content are defined in the guideline
Wikipedia:Identifying reliable sources (medicine) and are typically
review articles. Here are links to possibly useful sources of information about Shock (circulatory).
|
This article was the subject of a Wiki Education Foundation-supported course assignment, between 29 October 2019 and 6 December 2019. Further details are available
on the course page. Student editor(s):
Keo1274. Peer reviewers:
Naharris2.
Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT ( talk) 09:15, 17 January 2022 (UTC)
This article needs to mention psychological shock. -- Tarquin
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)
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)
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)
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)
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)
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)
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)
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)
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:
2 In intensive care medicine doctors use these references
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)
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)
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)
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:
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)
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)
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
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
3 Therapy taken from Irwin and Rippe:
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 ARTCILE Panthro
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 ARTCILE Panthro
It is best treated by rapidly restoring intravascular volume and perfusion as above.IN ARTCILE Panthro
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 ARTCILE Panthro
Anaphylaxis is treated with adrenalin and corticosteroids.MOSTLY IN ARTCILE Panthro
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
More suitable would be the use of vasopressors.IN ARTCILE Panthro
Obstructive shock: the only therapy consist of removing the obstruction.IN ARTCILE Panthro
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)
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
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.
3 Then this editor completely rewrites medical therapies for these conditions into: [4]
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)
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)
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)
http://www.alpharubicon.com/med/shockpalehorse.htm Panthro
Agreed. Panthro 22:00, 29 March 2006 (UTC)
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)
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.
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)
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)
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.
HI i would like to know if there is loss of consciousness during shock El thunder ( talk) 12:03, 24 June 2008 (UTC)
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)
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've added William R. Emerson, that is one of his works. Here it is listed [5].
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)
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)
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)
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)
{{
cite journal}}
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(
help); Unknown parameter |coauthors=
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suggested) (
help)
Doc James (
talk ·
contribs ·
email)
14:18, 30 August 2011 (UTC)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)
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)
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)
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)
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)
doi:10.1056/NEJMra1705649 JFW | T@lk 09:31, 26 January 2018 (UTC)
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)
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)
Naharris2 ( talk) 16:58, 15 November 2019 (UTC)
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)
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)
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)
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)