Veterinary Clinical Medicine-I (General and Systemic)

SUPPORTIVE THERAPY FOR SHOCK

Steroids

• The proposed benefit of steroids include stabilization of lysosomal membranes, prevention of lipid peroxidation, scavenging and stabilization of free radicals, and maintenance of adrenoreceptor function.
• Disadvantages are many, and include alterations of GI blood flow (especially in an already compromised GI tract), immunosuppression, vasodilation, and impaired wound healing. Multiple studies have failed to show any benefit of high dose steroid administration in any shock state. Low dose steroid administration (at physiologic doses) may be beneficial in anaphylactic or septic shock.

Antibiotics

• They should be administered only when indicated. In dogs, severe shock states are associated with GI tract hypoperfusion. This may cause ischemia-induced sloughing of the mucosal barrier, which allows bacteria to translocate from the gut lumen to the blood vessels. This often manifests as raspberry jam-like diarrhea which may have flecks of mucosa. If bloody diarrhea accompanies shock, broad spectrum antibiotics may be indicated.

Analgesia

• It is always indicated if shock is accompanied by pain. The physiologic response to pain is similar to that to shock, in that SNS activation causes tachycardia and peripheral vasoconstriction.
• Not administering opioids can make shock resuscitation more difficult since the physical manifestations of the pain response can easily be confused with prolonged shock. If the animal seems painful, opioids should be administered.
• The opioids are typically cardiovascularly sparing and can be titrated to effect. Hydromorphone, oxymorphone, buprenorphine, fentanyl or morphine (except in cats) can all be used with success.
• Butorphanol is generally not sufficient for treatment of severe pain. NSAIDs should be avoided in the shocky dog due to alterations in GI blood flow.