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Shock is what happens when the power goes out

September 27, 2010

Many definitions have tried to explain shock.  Unfortunately, some have left their mark too long.  For example, while most clinicians may claim they know otherwise, they still react to a low blood pressure (hypotension) as though it and shock are synonymous.  We’ve often seen patients’ blood pressures drop after a sedative or a narcotic are infused to keep them comfortable.  Physicians and nurses often respond with a fluid bolus, as though the patient is suffering from hypovolemic shock.  However, in most cases, the sedative and/or narcotic simply slowed down the patient’s metabolism so that their circulation didn’t need to work as much as it normally does.  The drop in blood pressure is simply a reflection of that.  The paradigm shift in medicine will be to fundamentally understand the nature of shock as well as the several mechanisms that can produce it.

Years ago, we lived in North Carolina when Hurricane Fran blew through.  It knocked out all the electricity for miles.  And it took days to weeks for it to be restored.  In our household, we couldn’t cook on our electric stove, so I bought a new gas grille.  We ate out of the refrigerator and freezer for a couple of days, but pretty soon, the food started to smell.  There were a few restaurants that had power, so we could go there to eat.  Our laundry piled up in the hallway outside the laundry room so that it was impassable.  I started to realize that if the power didn’t come on soon, we would have to move somewhere else to survive.

This was shock for our household.  Vital functions within our home were lost, such as nutrition and hygiene.  The circulation within our household corriders were blocked, which is analogous to diffuse intravascular coagulation, a syndrome often cited as responsible in part for the multiple organ failure that all-too-often follows an episode of severe shock.

Thus it is in the human body: when the power goes out, vital functions fail.  It can be an immediate process, occurring right before your eyes.  However, it can also be more drawn out, with a more chronic and subtle underperfused state leading to multiple organ failures down the road.  And once there are enough organ failures over a long enough period of time, death ensues.

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