Tipos de Choque! Você Sabe Reconhecê-los_ ABC da Enfermagem

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30/06/2022 01:33 Tipos de Choque! Você Sabe Reconhecê-los? ABC da Enfermagem
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(/)
Você Sabe Quais São os Tipos de Choque?
18/07/2019 Marcus Vinícius (/author/marcus/) Cardiovascular (/category/urgencia-e-emergencia/cardiovascular/) • Urgência e
Emergência (/category/urgencia-e-emergencia/)
Você Sabe Quais São os Tipos de Choque?
Antes de listarmos quais são os tipos de choque, é interessante entendermos o que é o estado de choque!
O que é Choque?
Choque pode ser definido como um reação desencadeada pelo organismo quando a circulação sanguínea não é suficiente para
perfundir órgãos vitais do corpo. Caso a causa do choque não seja resolvida haverá uma falência múltipla de órgãos.
Vale ressaltar que a circulação sanguínea tem a função de distribuir sangue com oxigênio e nutrientes para todos os tecidos
corporais. Quando por algum motivo, isso deixa de ocorrer e não há uma reversão desse quadro, ocorre o estado de choque.
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Conteúdo
1. Você Sabe Quais São os Tipos de Choque?
2. O que é Choque?
3. Você sabe quais são as causas do choque?
4. Fisiopatologia do Choque
4.1. Sistema Hematológico
4.2. Sistema Cardiovascular
4.3. Rins
4.4. Sistema Neuroendócrino
5. Tipos de Choque
5.1. Choque Hipovolêmico
5.1.1. Características do Choque Hipovolêmico
5.1.2. Choque Hipovolêmico provocado por hemorragia
5.1.3. Choque Hipovolêmico provocado por desidratação
5.1.4. Choque Hipovolêmico por sequestro de líquido
5.2. Choque Cardiogênico
5.2.1. Quais sãos as características do choque cardiogênico?
5.2.2. Sinais e sintomas do Choque Cardiogênico:
5.3. Choque Distributivo ou Vasogênico
5.3.1. Choque Séptico
5.3.2. Sintomas do Choque Séptico
5.3.3. Choque quente, hiperdinâmica ou inicial
5.3.4. Fase hipodinâmica, fria ou tardia
5.3.5. Choque Neurogênico ou Vascular
5.3.6. Choque Anafilático
5.3.7. Quais são os sinais e sintomas do choque anafilático?
5.4. Choque Obstrutivo
5.5. RESUMO: Tipos de Choque
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Portanto, o estado de choque é um conjunto sinais e sintomas provocado por uma intensa diminuição da perfusão sanguínea
gerando isquemia tecidual sistêmica (falta de oxigênio em todos tecidos).
Você sabe quais são as causas do choque?
Ao estudar a fisiologia cardíaca, entendemos que, para que a circulação sanguínea funcione, é preciso de 3 acontecimentos,
chamados de tripé da perfusão sanguínea, são eles:
1. O sangue deve circular pelo sistema vascular;
2. O coração deve contrair para que o sangue tenha a pressão necessária para circular pelo corpo; e
3. O sangue deve ter a pressão necessária para vencer a resistência vascular periférica.
Qualquer alteração em um desses
elementos, o choque irá se instalar!
Fisiopatologia do Choque
Para compreender os sinais e sintomas do choque, é preciso conhecer a fisiopatologia desse quadro.
Quando há uma falha na contração do coração, diminuição da volemia ou aumento da resistência vascular periférica, há uma
menor quantidade de sangue chegando aos tecidos. Isto gera hipóxia e falta de nutrientes.
Na tentativa de restabelecer o fluxo sanguíneo adequado para os tecidos, o organismo ativa o:
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30/06/2022 01:33 Tipos de Choque! Você Sabe Reconhecê-los? ABC da Enfermagem
https://www.abcdaenfermagem.com.br/tipos-de-choque/ 3/14
1. Sistema hematológico;
2. Sistema cardiovascular;
3. Rins; e
4. Sistema Neuroendócrino.
Para melhorar ainda mais os nossos estudos, vamos estudar a reação de cada sistema perante a deficiência de circulação
sanguínea provocada pelo choque.
Comecemos pelo sistema imunológico.
Sistema Hematológico
O sistema hematológico é ativado quando há a presença de hemorragia. Neste caso trata-se especificamente do choque
cardiogênico, que iremos estudar logo abaixo.
Neste sentido, o sistema hematológico ativa a chamada cascata de coagulação e os vasos sanguíneos contraem-se com a intenção
de cessar a perda de sangue.
Sistema Cardiovascular
Diante da diminuição da oferta de oxigênio e nutrientes para os órgãos vitais durante o estado de choque, o organismo estimula o
Sistema Nervoso Autônomo Simpático que por sua vez, libera adrenalina e noradrenalina na corrente sanguínea.
A adrenalina e noradrenalina aumentam a frequência cardíaca e faz vasoconstricção periférica. A diminuição da luz dos vasos
periféricos desloca o sangue da periferia em direção aos grandes vasos, ao mesmo tempo em que há o aumento da atividade
cardíaca.
EXCEÇÃO: No choque distributivo não há ativação do mecanismo de vasoconstricção. Leia o artigo até o final e veja o por quê?
Rins
Quando a pressãosanguínea está baixa nos capilares renais, os rins ativam o Sistema Renina Angiostensina Aldosterona (SRAA)
com a finalidade de aumentar a pressão arterial sistêmica.
O SRAA promove a retenção de sódio através dos rins e vasoconstricção periférica. Maiores quantidades de sódio no sangue
aumentam a volemia pois o sódio atrai moléculas de água.
Sistema Neuroendócrino
Quando o volume sanguíneo está baixo, receptores localizados no átrio esquerdo e nos grandes vasos pulmonares são ativados.
Por sua vez, sinais são enviados a partir desses receptores para o tronco cerebral e de lá para as células secretoras de hormônio
antidiurético (ADH). 
O hormônio antidiurético atua sobre os rins aumentando a retenção de água com a finalidade de elevar a pressão arterial e corrigir
o choque.
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30/06/2022 01:33 Tipos de Choque! Você Sabe Reconhecê-los? ABC da Enfermagem
https://www.abcdaenfermagem.com.br/tipos-de-choque/ 4/14
Agora que você já sabe o que é choque, vamos ver agora quais são os tipos de choque!
Tipos de Choque
Como já vimos, choque é uma síndrome provocada pela incapacidade do sistema circulatório em fornecer oxigênio e nutrientes de
forma adequada para o organismo.
A insuficiência circulatória causa danos nas células e lesão em vários órgãos, caso o choque não seja prontamente corrigido, os
danos tornam-se irreversíveis.
E quais são os tipos de choques?
São 4 tipos:
1. Hipovolêmico;
2. Cardiogênico;
3. Distributivo (Anafilático, Neurogênico e Séptico); e
4. Obstrutivo.
Agora vamos estudar cada um dos tipos de choque começando pelo choque hipovolêmico.
Choque Hipovolêmico
O choque hipovolêmico é provocado por uma redução acentuada do volume circulante no organismo devido a:
perda de sangue (quadros hemorrágicos);
perda de plasma (lesões traumáticas, queimaduras ou contusões); e
perda de líquido (diarreia, desidratação ou vômitos).
Características do Choque Hipovolêmico
O choque hipovolêmica é caracterizada por:
diminuição da pressão arterial;
redução da pressão venosa central (verificada na veia cava);
pressão venosa periférica baixa;
resistência periférica elevada (devido á ativada do Sistema Nervoso Autônomo Simpático);
Débito cardíaco baixo.
O choque hipovolêmico pode ser subdividido em mais três tipos de choque, saber:
1. Choque hemorrágico; 
javascript:
30/06/2022 01:33 Tipos de Choque! Você Sabe Reconhecê-los? ABC da Enfermagem
https://www.abcdaenfermagem.com.br/tipos-de-choque/ 5/14
2. Choque em decorrência da desidratação (comum em idosos e bebês); e
3. Choque em decorrência de sequestro de líquido.
Choque Hipovolêmico provocado por hemorragia
A Hemorragia é a perda abrupta de sangue provocada pela ruptura de vasos sanguíneos durante cirurgias, acidentes e outros. A
perda sanguínea leva á diminuição da oferta de sangue oxigenado para os tecidos instalando o choque.
Choque Hipovolêmico provocado por desidratação
A água é o principal componente do sangue e sempre estamos perdendo este líquido através da urina, suor, fezes, vômitos e
transpiração.  A desidratação também ocorre por febre, diarreia, vômitos, diabetes (quadros de hiperglicemia que provocam
excesso de micção), transpiração excessiva em dias quentes e
descontrole no uso de diuréticos.
Choque Hipovolêmico por sequestro de líquido
Pacientes em estado de anasarca, (edema generalizado), são fortes candidatos para choque hipovolêmico. Isto porque o sangue
perde água para o terceiro espaço e não há sangue suficiente para preencher os vasos sanguíneos.
Vale ressaltar que o edema é um exemplo de sequestro de líquido. A água desloca-se do espaço intravascular e passa a ocupar o
espaço intersticial (espaço entre células).
LEMBRE-SE: Choque hipovolêmico é causado por diminuição do volume de sangue.
Choque Cardiogênico
O choque cardiogênico, como o próprio nome diz, é o choque que tem sua origem no tecido cardíaco.
Como consequência, há uma falha no bombeamento do sangue devido ao enfraquecimento do músculo cardíaco, das válvulas
cardíaca ou do sistema de condução elétrica.
São situações que podem causar o choque cardiogênico:
infarto agudo do miocárdio;
insuficiência cardíaca congestiva;
arritmias;
miocardiopatias;
rejeição de transplante do coração.
Quais sãos as características do choque cardiogênico?
As características deste tipo de choque envolve:
Pressão arterial sistólica menor do que 90 mmHg;
Índice cardíaco baixo;
Resistência vascular periférica elevada;
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30/06/2022 01:33 Tipos de Choque! Você Sabe Reconhecê-los? ABC da Enfermagem
https://www.abcdaenfermagem.com.br/tipos-de-choque/ 6/14
Acentuada redução da fração de ejeção do ventrículo esquerdo.
Sinais e sintomas do Choque Cardiogênico:
Hipotensão;
Taquicardia;
Palidez cutânea;
Enchimento capilar lento;
Pulsos Finos;
Sudorese Fria;
Taquipneia;
Insuficiência Pulmonar;
Turgência Jugular;
Alterações do estão de consciência como agitação, confusão, sonolência ou coma.
LEMBRE-SE: O choque cardiogênico é um dos tipos de choque que é gerado no tecido cardíaco.
Choque Distributivo ou Vasogênico
O choque distributivo tem sua origem nos vasos sanguíneos através de condições que provoquem vasodilatação periférica. Assim,
o sangue corporal torna-se insuficiência para preencher todos os vasos sanguíneos.
Existem 3 situações que provocam vasodilatação periférica a ponto de instalar estado de choque, são eles:
1. Quadro de infecção generalizada – septicemia (choque séptico);
2. Quadro de reação anafilática – reação alérgica (choque anafilático); e
3. Trauma espinhar com perda do controle do sistema circulatório (choque neurogênico).
Choque Séptico
O choque séptico é uma complicação da septicemia, ou seja, de uma infecção generalizada. Os micro-organismos lançam toxinas
que provocam dilatação dos vasos sanguíneos de forma que a quantidade de sangue do organismo torna-se insuficiente para
preencher o sistema circulatório dilatado.
Além disso, as toxinas produzidas pelas bactérias causam uma inflamação descontrolada em todo o organismo paralisando órgãos
como os pulmões, fígado e rins.
O coração enfraquecido, tem dificuldade de bombear o sangue para o resto do corpo. Caso não seja tomadas medidas urgentes
para reverter o choque, o pacienta irá evoluir para a falência múltipla de órgãos.
Sintomas do Choque Séptico
Os sintomas do choque séptico envolvem 2 etapas, a saber:
1.  Choque Quente (Etapa inicial); e
2. Choque frio.
Choque quente, hiperdinâmica ou inicial
Os sintomas iniciais do choque séptico envolvem a fase quente e são decorrentes da da vasodilatação. São eles:
Extremidades quentes e ruborescidas;
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30/06/2022 01:33 Tipos de Choque! Você Sabe Reconhecê-los? ABC da Enfermagem
https://www.abcdaenfermagem.com.br/tipos-de-choque/ 7/14
Febre;
Taquicardia;
Pulsos amplos;
Alcalose respiratória;
Confusão mental;
Débito urinário normal;
Pressão arterial sistêmica normal ou ligeiramente baixa.
Fase hipodinâmica, fria ou tardia
Os sintomas mais tardios da choque séptico envolvem:
Cianose;
Pele fria e úmida (pegajosa);
Respiração rápida e superficial;
Anúria o oligúria;
Diminuição do débito cardíaco;
Redução do nível de consciência – Letargia, confusão mental, sonolência e coma;
Acidose metabólica – aumento do ácido lático (produção de energia sem a presença de oxigênio);
Leucocitose.
Choque Neurogênico ou Vascular
O choque neurogênico ocorre por lesão medular.
Este tipo de choque é gerado quando há lesões na medula espinhal e há uma perda do controle do sistema circulatório.
Sem o controle neuronal da vasos, ocorre vasodilatação e a quantidade de sangue circulante torna-se insuficiente para preencher
os vasos dilatados. Ocorre assim o choque vascular.
IMPORTANTE: Este é o o único tipo de choque que apresenta a BRADICARDIA como sintoma. Isto acontece porque o Sistema
Nervoso perde a capacidade de controlar o miocárdio.
Choque Anafilático
O choque anafilático é uma consequência grave de uma reação alérgica. Uma reação alérgica pode ser desencadeada por picadas
de insetos, alimentos, medicamentos ou qualquer substância em que o indivíduo seja alérgico.
A histamina liberada durante os quadros alérgicos promovem uma reação em cadeia que estimula de forma exagerada o sistema
imunológico gerando vasodilatação e colapso do sistema cardiorrespiratório.
Quais são os sinais e sintomas do choque anafilático?
Os sinais e sintomas do choque anafilático incluem:
Prurido;
Ardor na pele;
Edema Generalizado;
Dispneia;
Sensação de queimação na pele;
Perda da consciência;
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30/06/2022 01:33 Tipos de Choque! Você Sabe Reconhecê-los? ABC da Enfermagem
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Quais são os sinais de alarme da
dengue? (/dengue-sinais-de-
alarme/)
Infarto Agudo do Miocárdio (/iam-
significado-enfermagem/)
Como identificar um IAM? (/sinais-
e-sintomas-iam/)
Fisiopatologia do Edema
Pulmonar, Causas e Tratamento!
(/congestao-pulmonar-
fisiopatologia/)
Artigos Relacionados
Pulso fraco;
Morte.
Lembre-se que o choque anafilático, neurogênico e séptico são chamados de choque distributivo.
Choque Obstrutivo
O choque obstrutivo é causado por uma obstrução no miocárdio prejudicando assim o seu funcionamento. Este tipo de choque é
gerado por:
pneumotórax,;
embolia pulmonar maciça; e
tamponamento do pericárdio.
É importante mencionar que não existe o termo choque cardiovascular, sistêmico, maciço e nem pulmonar.
RESUMO: Tipos de Choque
Choque hipovolêmico – Desencadeado por hemorragia, traumatismo, sequestro de líquido, desidratação ou queimaduras extensas
que levam á perda de volume sanguíneo;
Choque cardiogênico – Originado no coração por disritmias, infarto agudo do miocárdio e outros;
Choque séptico – Desencadeado por sepse microbiana;
Choque anafilático – Ocorre em reações alérgicas graves;
Choque neurogênico – Ocorre devido a lesão medular;
Choque obstrutivo – Causado por tamponamento cardíaco, pneumotórax e embolia pulmonar;
Lembre-se que  são tipos de Choque distributivo:
choque séptico (septicemia);
neurogênico (trauma medular); e
anafilático(reação alérgica);
Leiamais sobre os tipos de choque, clique aqui! (/tipos-de-choque-enfermagem/)
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