Courtesy of Godoy Medical Forensics
In April, I covered delirium and noted that there are many underlying etiologies that can cause it. One such etiology is hypoperfusion. When the blood flow is cut off to the vital organs, the body will compensate in an effort to restore the blood flow. The body’s reaction to hypoperfusion is known as shock:
What is shock?
There are four main types of shock: Cardiogenic, Hypovolemic, Vasogenic or Neurogenic. Each type indicates the underlying cause of the hypoperfusion. The table below discusses each type expected symptoms.
|Cardiogenic||Decreased cardiac output||↓BP, poor tissue perfusion i.e. cyanosis, cool extremities and altered mental status||Pharmacological treatment and fluid resuscitation. PCI or CABG to decrease work of the heart and improve perfusion|
|Hypovolemic*Hemorrhagic||Rapid fluid/blood loss=decrease circulating volume=inadequate perfusion||↑HR, ↓BP, ↑RR, clammy skin, ↓urine output confusion and weakness||Prevent further blood loss, ventilation, fluid resuscitation and possible blood products and pharmacotherapy|
|Loss of normal vascular smooth muscle from vasodilation with compromised blood flow||↑temp, ↑HR, ↑RR, ↓BP, WBC ≥12,000 or ≤4,000, ↑lactate||Ventilation, fluid resuscitation, vasoactive medications and antimicrobial therapy|
|Neurogenic||Disruption of the nerve pathways in the spinal cord due to abnormal blood flow. Often caused by trauma or injury to the spine||Severe ↓BP, ↓RR, dizziness, ↓temp, nausea, faint pulse, cyanosis, chest pain||Immobilization, vasopressors, fluid resuscitation|
How does the body react to shock?
In general, a lack of blood flow to the organ results in that organ malfunctioning. Any of the organs can be affected by the lack of perfusion and the resulting symptoms will be directly related to the malfunctioning of that organ. Specifically, when the brain is affected, symptoms can be as mild as dizziness or as severe as coma. Delirium is one common symptom of shock, and this is a direct result of hypoperfusion to the brain.
How does this apply to criminal cases?
If a person is significantly injured from a motor vehicle accident, gunshot wound, stabbing, or any other major trauma, it is possible for them to go into shock. People with severe infections may go into septic shock. The lack of perfusion to the brain would then affect their mental state and their ability to answer questions appropriately or judge how their responses may affect them in the future. Extra caution should be used when a person is intoxicated as that may mirror their symptoms of shock. An assessment of the records by a medical expert is needed to determine if their injuries and condition were possibly due, at least in part, to shock.