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Shock is a state of circulatory dysfunction that results in insufficient oxygen delivery and other substrate to meet tissue metabolic demands.1 Inadequate oxygen delivery leads to a shift to anaerobic metabolism, eventually resulting in lactate production and metabolic acidosis.2 If this state persists, it can lead to multiple organ dysfunction and death.
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If unrecognized and untreated, shock progresses through three phases due to inadequate oxygen delivery.
Compensated: Homeostasis is maintained by the body's compensatory mechanisms.
Oxygen delivery is optimized by increasing oxygen extraction at the tissue level and maintaining blood flow to vital organs (e.g., heart, brain, and kidneys).
Blood flow to the gastrointestinal tract may be compromised.
Increased oxygen consumption leads to increased carbon dioxide (CO2) production, often resulting in an increased respiratory rate for CO2 elimination.
Uncompensated: Despite the body's compensatory mechanisms, cardiovascular compromise occurs, leading to inadequate microvascular perfusion.
Irreversible: Terminal or irreversible shock results from damage to key organs of such magnitude that death occurs. This occurs even if therapy returns cardiovascular parameters to normal.
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CLASSIFICATION OF SHOCK (SEE TABLE 28-1)
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RECOGNITION OF SHOCK AND ORGAN FAILURE
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