1. Shock (overview) Flashcards

1
Q

Although blood pressure (hypotension) is generally thought of when discussing shock, shock is actually a

A

CELLULAR DISEASE due to either inadequate perfusion (the O2 demand is greater than the oxygen delivered) or the inability of cells to utilize the delivered oxygen (issues with oxygen utilization/consumption).

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2
Q

Refer to figure 5-1 to study the pathophysiology of shock

A

Inadequate tissue perfusion OR impaired O2 uptake

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3
Q

There are 3 stages of all types of shock:

A
  1. Compensatory
  2. Progressive
  3. Refractory
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4
Q

The rapidity with which a pt progresses thru these shock stages ___

A

varies depending upon many factors.

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5
Q

During the COMPENSATORY STAGE of shock (figures 5-2 and 5-3), the blood pressure (bp)

A

is maintained as a result of 2 mechanisms: stimulation of the sympathetic nervous system and activation of the renin-angiotensin-aldosterone system (RAAS).

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6
Q

Sympathetic Nervous System Stimulation
figure 5-2 (physiology of compensatory stage of shock)

A

Decrease in cardiac output/circulating volume or increased oxygen utilization
I
V
sympathetic stimulation
I
V
(HR) Vasoconstriction (contractility)
I I I
I V I
I——> BP maintained <—————-I

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7
Q

Renin-Angiotensin-Aldosterone System (RAAS) Activation
Figure (5-3) Compensatory stage of shock due to RAAS

A

Decrease in CO/circulating volume or increased o2 utilization leads to RAAS ACTIVATION which
leads to

a) Renin secretion –>Angiotensin I–>Angiotensin II ———->Vasoconstriction—->BP maintained

b)Aldosterone release–>Na+ and H20 retention–>BP maintained

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8
Q

Clinical Signs/Symptoms of the Compensatory Stage of Shock (BP maintained)

A

-tachycardia
-tachypnea, respiratory alkalosis
-Normal PaO2
-Oliguria
-Skin is pale, cool (except in early sepsis)
-Restlessness, anxiety
-Complaints of thirst
-Remember, BP IS MAINTAINED

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9
Q

Clinical Signs/Symptoms of the PROGRESSIVE Stage of Shock (Compensatory mechanisms failing)

A

-HYPOTENSION
-Worsening tachycardia, tachypnea, oliguria
-metabolic acidosis
-decreased PaO2
-clammy, mottled skin
-further change in LOC
-the pt may complain of nausea

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10
Q

Clinical Signs/Symptoms of the REFRACTORY Stage of Shock

A

-pt not responsive to interventions

-Severe systemic hypoperfusion, MULTIPLE ORGAN DYSFUNCTION SYNDROME (MODS)

-The pt may survive shock, but die from failure of one or more organs
-Pulmonary (ARDS)
-Kidney (acute tubular necrosis)
- Heart (failure, ischemia)
-Hematologic (disseminated intravascular
coagulation)
- Neurological (encephalopathy, stroke)
- Liver (failure)

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11
Q

Types of Shock:

A

-Hypovolemic
-Septic
-Anaphylactic
-Neurogenic (seldom tested)
-Cardiogenic (covered in CV)
-Obstructed (covered in CV and Resp chapters)
-Tension pneumothorax
-Massive pulmonary embolism
-Cardiac tamponade

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