User:It's gonna be awesome/Combined shock

Combined shock refers to a combined form of clinical shock that is contributed by multiple non-clinical shock types or when underlying disorders being added to a non-clinical shock. It can also refer to a severe shock exacerbated by several types of clinical shock.

Although shock is divided into four types, people, in clinical settings, may present a combination of various shock types. Thus, a patient can actually receive a diagnosis of the combined shock.

Examples
A severe infection can dispose a person in both dehydration as well as vasodilation which are initially attributed to hypovolemic shock and distributive shock, respectively, besides septic shock. Hemorrhage shock because of blood loss from an open wound may be complicated by the distributive shock of systemic inflammatory symdrome or fat embolism. People with cardiomyopathy may seem like having hypovolemic shock due to excessive diuresis and in combination with decompensated tachycardia and/or stroke volume. Enlarged spleen may partially or completely block the blood flow in the artery causing bruit or obstructive shock, respectively. A spinal cord injured person may suffer not only neurogenic shock as a result of dysautonomia due to the spinal cord trauma but also myocardial depression because of significant increase in visceral sympathetic activity with coronary artery constriction from autonomic dysreflexia which could turn out into cardiogenic shock. People with ruptured left ventricular free wall aneurysm can have cardiogenic shock from heart failure. Cardiac tamponade associated with ruptured aneurysm in heart can lead to obstructive shock or hypovolemic shock when blood is trapped in or lost but absent from pericardial sac. Undetectable gastric ulcer that is perforated into the pericardium is rare but can result in shock. A dinstributive shock featuring low vascular resistance may further combine an obstructive shock and cardiogenic shock when massive volume resuscitation leads to abdominal compartment syndrome as well as acute right heart syndrome. Chest trauma more often than not leads to a combined shock of obstructive shock featuring tension pneumothorax and hypovolemic shock characterized by massive bleeding.

Signs and symptoms

 * Fluid-responsive and non fluid-responsive hypotension.
 * Drug-resistant hypotension.

Cause

 * Enduring sub-clinical shock ensued from the late identification or improper treatment for the preceding shock. Frankly, if the root cause of shock in the early days wasn't well-treated despite adjustments of the macro-hemodynamic variables, the ensuing sub-clinical shock may end up evolving into a new round of physical deterioration or refractory shock.

Management
Reparation of the metabolic acid-base imbalance, and rectification of the patient's state deficient in nutrition.