Shock In The Medical Sense

Definition

Shock in the medical sense is an emergency situation. With this information, you can recognize a shock and provide useful first aid. Colloquially, a shock scares us – or we are paralyzed, shocked for a short time. For medical professionals, however, shock is a serious life-threatening clinical picture. Read more about the causes, symptoms, and first aid here.

What is a Shock?

A shock in the medical sense is a condition in which the oxygen supply to the organs is no longer ensured due to a lack of blood in the bloodstream. This deficiency can have very different causes. The most common are internal and external bleeding (mostly due to injuries) as well as disorders of the fluid balance, which continue to reduce the blood volume. Long-term diarrhea, massive vomiting, or profuse sweating can also cause shock. Doctors refer to these causes as a volume deficiency shock.

If enough blood is no longer pumped into the body in the event of heart failure, those affected also fall into a state of shock. Medics say they get shocked. The technical term for this form of shock is cardiogenic shock.

Symptoms

In order to supply the body with vital oxygen, the heart rate rises to more than 100 beats per minute at the beginning of the shock. Typically, the blood pressure drops sharply (first value below 90 mmHg).

Shock states can also be recognized externally: The skin is pale and usually feels cool and moist. People in shock are often very thirsty. The longer a shock lasts, the shallower the breathing becomes. The blood pressure continues to drop, the pulse is racing and can hardly be felt. Eventually, those affected lose consciousness.

Shock In The Medical Sense

Depending on the cause of the shock, there are other symptoms:

    • in anaphylactic shock: allergic symptoms such as rashes, itching, facial swelling, and shortness of breath
    • in cardiogenic shock: chest tightness and difficulty breathing
    • with septic shock: fever or reduced body temperature below 36 degrees Celsius and bleeding in the skin, the skin is sometimes red and overheated.

Causes

Allergy sufferers know anaphylactic shock as the most severe allergic reaction. Many allergy sufferers carry an emergency kit with them in order to be able to take action against the life-threatening allergy-related shock condition.

In the case of blood poisoning (sepsis), septic shock can develop in the end-stage. This almost always leads to death.

In addition, there are even rarer forms of shock such as neurogenic shock (nerve-related), electric shock (as a result of an electrical accident), endocrine shock (hormone-related), hypoglycemic shock (insulin shock), and orthostatic shock (due to a disturbed vascular and circulatory regulation).

Examination

Recognize shock with the Rekap sample

Rescue workers often use their fingernails to test for shock. But every layperson can do that too. The so-called Rekap-Probe consists of briefly pressing the fingernail into the nail bed. The blood under the nail is squeezed out of the smallest blood vessels, the capillaries, and the skin turns white. If you let go of your fingernail, you pay attention to the time it takes for the skin under the nail to turn red again. If this so-called recapillarization (recap) lasts longer than a second, it can be seen as an indication of poor blood circulation. Of course, this is not a reliable diagnostic criterion, but it is still a guide.

Treatment

First aid: ensure shock positioning and call an emergency doctor

If a shock is suspected, the emergency services should be alerted immediately. Until the emergency vehicle arrives, first aid with so-called shock positioning is possible. The legs are positioned higher than the head, for example, the patient lies on their back and the legs are placed on a chair/stool. This is intended to increase the return of the blood to the heart and improve the supply of organs.

No shock position for B injuries

However, there are a number of shock states in which the shock positioning is not useful and even harms. Many rescue workers remember these cases with a donkey bridge. It reads: “B = shock position nee”. These include the following 6 Bs:

    • Pear: visible and invisible head and skull injuries, fluid leakage from nose and/or ears
    • Chest: pain in the heart and chest area
    • Abdomen: Injuries or pain in the abdomen
    • Legs: open broken legs with protruding bones or any suspicion of a broken leg
    • Pelvis: Injuries in the pelvic area
    • Hump: Injuries to the back and spine, especially with numbness or paralysis of the limbs or uncontrolled urination and stool.

Don’t panic about first aid

Most people very rarely get into situations where they have to respond to shock. Most often this happens in traffic and work accidents. No matter how severe the accident is: First get an overview, then secure the accident area and then alert the emergency services. After that, you can give first aid. This is the best way to help yourself and others to survive a state of shock in good health.

Everything About A Cough

Talk about everything about a cough the possible causes and treatment, cough is less of a disease in its own right than a symptom of respiratory disease. It occurs, for example, when we have choked. However, coughing can also indicate serious medical conditions such as heart failure or reflux disease.

Definition

Who does not know the nights disturbed by a cold-related cough or the pain of a dry cough or dry cough? The bronchi are burning and you are short of breath. After a coughing fit, we sometimes feel like we have sprinted 100 meters. If the cough then loosens a little and produces sputum, this is often perceived as a relief.

Cough is not an independent disease in the medical sense, but a symptom. As a rule, a cough is triggered by illness. The most common are respiratory infections such as bronchitis, colds, or the flu. Allergies, asthma, or smoker’s cough are other common causes of coughs. Heart failure or drug side effects such as the ACE inhibitor cough are also causes of cough.

Symptoms

Doctors classify the symptom of cough into categories. First of all, a distinction is made according to the duration:

    • According to the medical definition, acute cough lasts up to 8 weeks.
    • Subacute cough is a classification that is sometimes used for coughs lasting between 3 and 8 weeks.
    • Chronic cough is the name given to a cough that lasts longer than 8 weeks.

In addition to this distinction based on duration, there is a division into productive and unproductive or dry cough:

    • Productive coughing is accompanied by increased secretion and expectoration.
    • Unproductive (dry cough) is also known as a dry cough. Mucus does not form with this form of cough. Therefore, unproductive cough is dry, so it remains without expectoration.

Everything About A Cough

Symptoms Of Productive Cough

A productive cough is characterized by the fact that the cough removes sputum from the airways or lungs. Often a productive cough begins with a dry cough. After usually 1 to 3 days, often accompanied by a sore throat, there is an increased production of mucus. This bronchial mucus is transported out of the airways or the lungs as sputum via the cough reflex.

Symptoms Of Unproductive Cough

An unproductive cough feels hard and painful, often burning. It does not produce sputum. Coughing fits that can last for minutes are also typical of dry coughs. Coughing attacks are said to occur more frequently at night and thus deprive the sick of sleep. Oftentimes, a dry cough is accompanied by allergy symptoms. Heartburn can also occur along with a dry cough.

More Symptoms Of Cough

The frequency and sound of coughing attacks are further characteristics that can sometimes even be used to determine the cause. Barking cough in small children, for example, suggests pseudo croup. An attack-like cough with a high repetition frequency like a staccato is typical of whooping cough (pertussis). A morning cough, often with copious expectoration, is particularly common among smokers.

Causes

The Cough Reflex

The cause of cough is the cough reflex. This is an innate protective mechanism of the body. The cough reflex has the task of protecting the respiratory tract from damaging influences and of removing secretions such as mucus and foreign bodies such as dust or swallowed items.

The cough reflex is triggered by receptors in the mucous membranes of the larynx, the trachea, and the larger bronchi. They react to mechanical stimuli such as those caused by secretions (mucus), foreign bodies (smoke, dust, swallowed things) or other stimuli (inflammation, gases). These stimuli reach a certain brain region, the medulla oblongata, via the vagus nerve (nervus vagus or 10th cranial nerve).

The medulla oblongata houses the respiratory center and is located in the brain stem. These nerve fibers are activated, which cause a sudden contraction of the diaphragm and the muscles of the abdominal wall and intercostal. In addition, the glottis is narrowed and extreme pressure builds up under the closed larynx.

When the lid of the larynx opens, exhalation occurs suddenly. With this impulse, foreign bodies or secretions are thrown out of the windpipe like an explosion. When coughing, enormous forces act on the larynx muscles. With strong coughing attacks, the air flows through the larynx at speeds up to the sound limit.

Causes Of Productive Cough

A productive cough is most often a symptom of a respiratory infection. These are, for example, the flu or cold, which in turn are accompanied by fever, runny nose, and a more or less pronounced feeling of illness. If the underlying disease is not healed properly or if there are constant new infections, the cough can become chronic; doctors speak of chronic bronchitis.

Causes Dry Cough

Dry cough is usually a reaction to a variety of harmful stimuli. These include smoke, dust, gases or chemical vapors. A very common typical example is the smoker’s cough.

Other causes of dry cough are severe respiratory diseases such as whooping cough, tuberculosis or lung cancer (bronchial carcinoma) as well as pulmonary embolism or emphysema. Allergic asthma or other allergies can also trigger a dry cough.

Other Causes Of Cough

Medicines can also trigger a cough. For example, this is a common side effect of some drugs for high blood pressure, such as ACE inhibitors.

Irritation from stomach acid when stomach contents flow back into the esophagus (reflux disease) also leads to coughing. This is often accompanied by heartburn and acid regurgitation.

Examination

Diagnosing cough is easy based on the symptoms. To find out the exact cause, your doctor will first ask you in detail. This is followed by a physical examination, during which mainly the breathing sounds are listened to.

In the case of a productive cough, the color and texture of the sputum indicate the possible cause:

    • Clear whitish sputum: mostly caused by viral upper respiratory infections such as colds or flu
    • Yellowish or green sputum: indication of a possible additional bacterial infection in viral respiratory diseases
    • The bloody build-up is an indication of serious lung diseases such as pneumonia, pulmonary embolism, or lung cancer. In addition, the sputum is sometimes bloody if the blood vessels in the airways or the lungs have been damaged by swallowed objects or other injuries. Bloody sputum is usually a medical emergency and should be investigated immediately.
    • Brown or black sputum: especially common in smokers, often signs of advanced lung damage from chronic bronchitis or COPD.

At times, complex diagnostics may be necessary to find the cause of the cough. These more extensive examinations are usually carried out by specialists. As a rule, your family doctor will refer you to a pulmonologist (pulmonologist) for this purpose. For heart-related coughs, cardiologists are the specialists of choice. In the case of gastrointestinal diseases as the cause, the path leads to the gastroenterologist and in the case of allergies to the allergologist.

Treatment

Treatment for cough is based on the cause. If a cough is not triggered by a serious underlying disease, home remedies are usually well suited to relieve the excruciating urge to cough. If the cough does not improve within a few days, the first thing you should do is see a family doctor so that the cause of the cough can be found. Only then can meaningful treatment be initiated.

There are a number of medications your doctor can use to treat coughs. If necessary, he will treat infection or inflammation as the cause of the cough, for example with antibiotics. If ACE inhibitors are responsible for the cough, he will change the medication. In the event of a cough accompanied by heartburn and acid regurgitation, the doctor will order a gastroscopy and then treat the gastric acid reflux.

Do not take coughing lightly. This is especially true if the cough:

    • lasts longer than 2 weeks (for infants, toddlers, or children: longer than 3 days)
    • is accompanied by fever or severe malaise
    • occurs new and without a traceable harmless cause
    • with bloody, brown, or black obstruction
    • is accompanied by a high fever and/or extreme fatigue.

More information about treatment and self-help, as well as home remedies for coughs:

    • bronchitis
    • COPD
    • cough

Prevention

Coughing as a result of respiratory infections can hardly be prevented in a targeted manner. Basically, it is advisable to strengthen the immune system. A varied diet rich in vitamins and exercise in the fresh air strengthens the immune system and therefore helps prevent coughs. Smokers should give up smoking, especially if they have a smoker’s cough.