Prognosis and Treatment of Shock

If shock goes untreated, it is generally fatal. The mortality rate from cardiogenic shock after a myocardial infarction and from septic shock is 60% to 65%. Of course, the actual prognosis depends on the cause of shock, any comorbidities, and the time between onset and definitive treatment all contribute to whether or not a patient will survive (Weil, 2007).

Reinstituting adequate perfusion to the organs is the primary goal in treating shock. It is essential to maintain adequate oxygenation, blood pressure, and maintaining adequate cardiac function. Specific treatment depends on the cause. There is a delicate balance between maintaining the patient's blood pressure to be able to transport the patient to the hospital safely and trying to get the patient to the hospital within the "golden hour" .

When a patient is in shock, the first priority is to maintain airway, breathing, and circulation as adequately as possible until the patient can be transferred to the hospital for more definitive treatment. First-order management that can be undertaken by EMT personnel include holding pressure to open wounds that are bleeding, providing IV fluids, and giving the patient oxygen supplementation.

Keeping the patient warm is important and at this point, nothing is given by mouth (Weil, 2007). Patients with signs or symptoms of an acute MI or pulmonary edema are given smaller amounts of fluid to avoid venous congestion and pulmonary complications with fluid overload (Weil, 2007). More definitive care will be given once the patient is able to be monitored in the hospital (Wedro, 2007).

When the patient gets to the hospital, they will probably be monitored in the intensive care unit with ECG, blood pressure monitoring (usually through an arterial line), vital sign monitoring, pulse oximetry, urine flow (via catheter), and mental status monitoring. Measurement of CVP and cardiac output may also be instituted.

Routine bloodwork such as a comprehensive metabolic panel, complete blood count, clotting factors, arterial blood gases, and lactate will also likely be initiated. Intramuscular medications are avoided due to the decreased perfusion to the musculature during shock. Most medications are administered IV if possible. After the initial corrective measures are taken to stabilize the patient, further diagnostics will be performed to evaluated the need for more advanced interventions like surgery. The type of diagnostics needed will depend on the circumstances surrounding the event.