Aspects of the management of shock

Shock is a state of systemic imbalance between supply and demand for oxygenated blood. We discuss here management of shock states not primarily of cardiac origin. Inadequacy or maldistribution of blood volume is important in the pathogenesis of most forms of shock. The Military Anti-Shock Trouser (MAST) suit assists the redistribution of blood from the periphery to the central circulation. Normal saline and Ringer's lactate solution may be used interchangeably for acute volume replacement. Colloid replacement requires smaller volumes but carries a higher risk of pulmonary edema, whereas crystalloid replacement requires larger volumes and leads to more systemic edema. Myocardial injury may contribute notably to the transition from reversible to irreversible shock. Naloxone, lidocaine, and indomethacin have improved survival in animal models of endotoxin shock, but proof of efficacy in humans is lacking. A role for corticosteroid administration in shock remains to be defined. Effective antibiotic therapy is the best treatment for septic shock; antisera against endotoxic antigens may develop as important adjunctive therapy.