Shock - Good Things, Badly Out of Control

Abstract

Shock occurs when the circulatory system fails to adequately nourish the body's cells and may arise from several causes including severe trauma. On the one hand, shock is associated with several good things, including rapid recognition of invading pathogens, immune stimulation and rapid activation of host defense, rapid immobilization of invading pathogens, rapid eradication of invading pathogens and many more, all meant to shield the body against the negative effects of malfunctioning circulation and to enhance host defense against pathogens. On the other hand, however, if shock remains untreated, good things get badly out of control, failing to de-activate host defense after eradication of invading pathogens, failing to activate host defense against remaining pathogens rapidly enough and eradicating invading pathogens at the host's expense. As a result, the patient is forced into a vicious cycle of immune overstimulation and multiple organ dysfunction, eventually leading to immune burn out, hypercatabolism and septic multiple organ failure. In the trauma patient, the stage for this vicious cycle is set immediately after trauma, during the first hours of hemorrhagic-traumatic shock. Therefore, shock should be treated as early as possible, before good things get badly out of control, driving the patient towards septic multiple organ failure and death.

Key words

trauma - hemorrhage - sepsis - systemic inflammatory response - mediators - translocation - multiple organ failure

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