Obstructive shock is a type of shock caused by obstruction (or blockage) of large blood vessels (such as the aorta) or the heart itself. As a result, blood flow out of the heart muscle is reduced, triggering inadequate circulation and insufficient oxygen supply to vital organs. The crucial aspect of treating this serious medical emergency is to quickly identify the cause of the obstruction and eliminate it as soon as possible to restore normal conditions. It goes without saying that if you suspect an individual is in obstructive shock (or any other form of shock), you should call 911 and get help as soon as possible.
Steps
Part 1 of 3: Identify the Cause
Step 1. Check for massive pulmonary embolism
A blood clot in the lungs can cause obstructive shock, manifesting as sudden chest pain, shortness of breath, and subsequent shock symptoms. Massive pulmonary embolism is diagnosed by means of a transesophageal echocardiogram or an angiographic computed tomography of the chest; these are the safest methods to ascertain the presence and exact location of the thrombus.
Step 2. Consider the possibility of a tension pneumothorax
This is another etiological possibility of this form of shock. Breathing noises from the affected side decrease, the trachea changes from central to lateral, and the patient complains of chest pain and trouble breathing. It is more common among young individuals who have suffered a trauma or an accident; however, it can run wild in anyone, often due to a rapid pressure surge, such as that occurs during air travel.
Tension pneumothorax is clinically diagnosable and should be treated immediately when it is suspected that it may be the cause of obstructive shock
Step 3. Look for symptoms of cardiac tamponade
The blood stagnates around the heart, increasing the pressure and thus preventing the heart muscle from ensuring proper circulation throughout the body. The greater the stagnation, the worse the circulation becomes, resulting in the manifestation of signs of shock.
This disorder is often associated with anxiety, sudden chest pain that worsens with deep breathing or coughing, difficulty breathing, dizziness and / or fainting, pale, gray or bluish skin due to poor breathing
Step 4. Evaluate "constrictive pericarditis" as a possible cause of obstructive shock
In this case, the sac surrounding the heart (called the pericardium) becomes inflamed and the scar tissue that develops over time becomes more and more tense; as a result, the heart is subjected to stress because it has less and less space available to beat. "Bacterial pericarditis" (an infection of the pericardium) can trigger obstructive shock through the same mechanism.
A patient with constrictive pericarditis complains of difficulty in breathing, swelling of the legs, ankles and abdomen (due to reduced venous return), chest pain and, in severe cases, the typical signs of obstructive shock
Step 5. Consider aortic stenosis
In this case, the valve that allows blood to leave the heart becomes narrower, becomes blocked, or compresses in some way, reducing the range of each heartbeat. When the situation becomes severe, it can trigger obstructive shock due to very little blood leaving the heart and reaching vital organs.
- This condition is often accompanied by chest pain, dizziness and / or fainting, gradual decrease in resistance to exercise over time, palpitations (the sensation of irregular heartbeats), heart murmur that can be felt with the stethoscope.
- The situation gradually worsens over time and, in severe cases, can manifest the signs and symptoms of obstructive shock.
Part 2 of 3: Treating the Causes
Step 1. Remove the thrombus in the case of massive pulmonary embolism
If the shock is caused by this disorder, it is imperative to intervene promptly. Sometimes, a "thrombolytic" (clot-dissolving) drug may be considered to treat diffuse pulmonary embolism; however, in the presence of severe shock, surgery or catheter insertion is preferred, as these are the quickest and safest ways to get rid of the clot and relieve the obstruction.
Step 2. Use a needle and drainage catheter to resolve hypertensive pneumothorax
In this case, you need to insert a needle into the affected area of the chest to relieve the tension. This procedure is called "decompression". After inserting the needle, treating the pneumothorax, and stabilizing the shock symptoms, the drainage tube is left in place as an ongoing solution and as a prevention.
Step 3. Get pericardiocentesis to treat cardiac tamponade
Doctors use a needle to remove fluid from the pericardium pouch. Draining the fluid (which is usually blood) relieves the pressure around the heart and clears the blockage that is causing the shock.
- Obviously, it is necessary to understand the etiology of cardiac tamponade in order to definitively resolve the shock.
- If necessary, pericardiocentesis is done several times to reduce pressure until the underlying causes are identified and resolved; in other situations, a surgical procedure known as a "pericardial window" is done to reduce fluid buildup.
Step 4. Treat constrictive pericarditis as needed
If this pathology (or a related disorder) is the cause of the shock, it is necessary to understand what is the factor that triggers the compression and stiffening of the pericardium; if the situation cannot be resolved and treated quickly, surgery must be performed to relieve the pressure around the heart and eliminate the symptoms.
Step 5. Treat severe aortic stenosis if it is responsible for the shock
An aortic counter-pulsator is used to open the valve, allowing blood to flow out of the heart and into vital organs. This type of surgery has been shown to be effective in resolving symptoms of obstructive shock when the underlying etiology is aortic stenosis. The valve should be evaluated and, if the criteria are met, replaced.
Part 3 of 3: Stabilize Vital Signs and Treat Shock
Step 1. Improve the victim's blood pressure
One of the main problems with any type of shock (including obstructive) is dangerously low blood pressure. When the systolic value is greater than 90 mmHg, it ensures an adequate flow of oxygen to the vital organs; however, whenever it falls below this limit (a typical event in a state of shock), organ function is compromised and a multi-organ dysfunction syndrome could lead to life-threatening results if not treated.
- The doctor gives drugs (called "vasopressors") that cause the blood vessels to contract and consequently raise the pressure.
- Medicines are also provided to increase the contraction of the heart muscle (called "inotropes"), which allow the blood to reach the peripheral tissues.
Step 2. Increase the patient's blood volume
In addition to improving the heart's ability to contract and the firmness of blood vessels through the use of medicines, doctors can also consider other ways to increase the person's blood volume in shock and increase blood pressure accordingly. Here are some examples:
- Intravenous administration of fluids, such as normal saline or lactated Ringer's. Both increase the volume of fluids in blood vessels by raising pressure and helping blood to reach vital organs;
- Blood transfusion in anemic patients. This solution is less common in cases of obstructive shock (unlike what happens with other forms of shock); however, when the situation is dire, it is regarded as a last resort.
Step 3. Proceed with cardiopulmonary resuscitation if needed
If the shock is severe enough to cause the victim to lose consciousness and pulse, follow the resuscitation procedure and advanced emergency protocols, not forgetting to remove or alleviate the cause of the obstruction (in case of obstructive shock). If you don't have professional medical training, call 911 and have the person get to the hospital as soon as possible.
