Chapter 13: Shock Flashcards
Define Shock:
Inadequate cellular perfusion, Hypoperfusion
Define Perfusion:
Circulation of blood to tissues in an adequate amount to meet cells’ needs.
What can cause inadequate perfusion?
Blood Vessels: Dilation - infection, drug overdose, spinal cord injury, anaphylaxis
Blood: Blood/plasma loss vomiting/diarrhea, trauma 2 vessels/tissues
Heart: Damage b/c disease or injury X pump properly - heart attack, heart trauma, obstructions (large pulmonary embolism)
1+ not working in shock
What causes each type of shock?
Pump failure: Cardiogenic Shock, Obstructive shock - tension pneumothorax, cardiac tamponade, pulmonary embolism
Poor vessel Function: Distributive shock- septic, neurogenic, anaphylactic, psychogenic
Low fluid volume: Hypovolemic shock- hemorrhagic, nonhemorrhagic
Cardiogenic Shock:
Caused by insufficient cardiac output (because of destruction or inflammation) (because poor contractility, low preload (pressure of blood entering heart), high afterload (pressure blood works against while leaving heart)
Signs: Tachypnea, crackles/rales
Obstructive shock:
Caused by obstruction
Signs/Symptoms: blunt/penetrating trauma
- cardiac tamponade: fluid/blood between pericardial sac & myocardium (pericardial effusion) preventing heart from filling w/ blood
-signs: jugular vein distention, muffles heart sounds, narrowing pulse pressure
-Tension pneumothorax: Damage 2 lung tissue, air enters cavity pushing mediastinum cause vena cava X able to remain open
-signs: decreased blood pressure, unilateral absent lung sounds, difficult bag-mask ventilations, cyanosis, tracheal deviation
-Pulmonary embolism
Distributive Shock:
Caused by widespread dilation of arterioles, venules, or both leading to pooling in vascular beds
-Septic shock: severe infections, plasma loss, vasodilation, fluid in alveoli difficulty respiration
-signs: Temp below/above 96.8-100.9, respiration greater than 20 bpm, acute AMS, BGL <120 mg/dL, systolic BP <90mmHg, SpO2 <90%
-Neurogenic Shock: Spinal cord injury or brain conditions (tumors or spina bifida) nerve signals cut off leads to vasodilation loose ability to control temp
-signs: no sweating below injury, hypotension, normal/low heart rate, normal skin
-anaphylactic shock: react quickly to substance X cause reaction before (injection, stings, ingestion, inhalation) w/i minutes
-signs: skin: flushed, itchy, burning, hives, edema, pallor, cyanosis Circulatory system: dilation, increased permeability, bp drop, weak pulse, Respiratory: sneezing/itching, stridor, obstruction, chest tightness, wheezing & dyspnea, fluid & mucus secretion causing coughing, bronchi constriction, forced expiration, cessation of breathing, Other: abdominal cramping, nausea, vomiting, altered mental status, dizziness, fainting & coma
-Psychogenic: sudden nervous system reaction causing vasodilation and fainting or syncope-temporary blood pooling causing brain to not get enough blood to function properly (syncope can have life-threatening causes)
Hypovolemic Shock
hemorrhagic and non-hemorrhagic causes: diarrhea, vomiting, blood/ plasma loss,
What is the progression of shock?
Compensated shock: body can still compensate for blood loss
Decompensated shock: Body cannot compensate, and mental status is declining
Irreversible: unable to resuscitate
In what emergency conditions should shock be expected?
Internal/external bleeding, multiple severe fractures, abdominal/chest/spinal injury, severe infection, major heart attack, anaphylaxis
Treatment for Shock:
Adress external bleeding before ABCs,
1. Transport efficiently
2. High-flow oxygen
3. Keep patient warm
4. Shock position
5. Request ALS
Reassess every 5 min
The signs of compensated shock:
Agitation, anxiety, restlessness, feeling of impending doom, weak rapid (thready) pulse, clammy (pale, cool, moist) skin, pallor (w/ cyanosis around lips), shallow rapid breathing, nausea or vomiting, capillary refill >2sec for infants and children, marked thirst, narrowing pulse pressure.
The signs of decompensated shock:
Falling blood pressure, declining mental status/ altered LOC, labored or irregular breathing, ashen mottles or cyanotic skin, thready or absent peripheral pulse, dull eyes, dilated pupils, poor urinary output.
