CH 8: Shock

Question 1

What is perfusion?

Answer 1

Perfusion is the supply of O2 to cells. If a patient has good perfusion, then their cells are receiving the O2 they need.

Question 2

What is Shock?

Answer 2

A lack of tissue perfusion that results in anaerobic metabolism.

Will result in cell death, and organ dysfunction.

Is detectable if vital signs are taken in Secondary assessment.

Question 3

To go into Shock, 1 of 3 foundational things must happen:

Answer 3

1) Heart is not functioning properly and blood is not circulating.

2) Inadequate amount of blood circulating, due to a loss that the body cannot compensate for.

3) Intact blood vessels unable to regulate blood flow effectively. AKA loosing their ability to vasoconstrict and vasodilate, without physical damage.

Question 4

Organ tolerance to ischemia (time before tissue dies)

Answer 4

Brain, heart lungs: 4-6 mins

Kidneys, Liver, GI tract: 45-90 mins

Muscles, bone & skin: 4-6 hours

Question 5

Shock sub-type: Cardiogenic

Answer 5

Is a result of a problem with the heart itself. (Ex MI)

Question 6

Shock sub-type: Obstructive

Answer 6

Something physically prevents the heart from filling/emptying despite pumping normally. (Ex Pulmonary embolism)

Question 7

Shock sub-type: Hypovolemic and its sub-types

Answer 7

General term related to insufficient volume of blood circulating in the system (true/relative relates to physical changes)

Hemorrhagic (true): Vascular system looses large quantities of blood. (Ex Internal and external bleeds)

Neurogenic (relative): Nervous system looses its ability to control constriction/dilation of vessels (Ex Spinal cord injury)

Psychogenic (relative): Blood vessels dilate due to any kinds of stress.

Septic (relative): Infections release toxins into the blood causing dilation. (Ex allergies)

Anaphylactic (true): Increases permeability of blood vessels allowing fluid to leech out of circulatory system, reducing volume over time.

Question 8

Stages of Shock (3)

Answer 8

Compensated: Body initially detects low perfusion and attempts to restore normal circulation thru vasodilation focused on vital organs.

Decompensated: Compensatory mechanisms are unsuccessful and body tissue becomes hypoxic. Interventions can still have an effect. Decreased O2 to brain results in steady decline of LOR

Irreversible: Vascular system becomes too tired to maintain compensatory measures and blood pools in extremities, away from vitals organs. Patient will not survive regardless of intervention.

Question 9

How do you treat shock?

Answer 9

1) Early recognition and care for serious injuries that could result in shock.

2) Patient positioning in recovery or with feet elevated to improve blood flow (only if SMR is not indicated, and no CV system damage is detected)

3) Maintain normal body temperature

4) Provide O2 if necessary