Shock Flashcards
Define “shock”
When the body’s tissues do not receive enough oxygen nor is their removal of waste products
T/F
Shock is a disease
False. Shock is a syndrome.
What does shock usually result from? (3)
- Ineffective pumping
- Insufficient volume
- Massive vasodilation
When the body is not able to perfuse the tissues with oxygen, what happens to the blood glucose levels?
Blood glucose will sky rocket
When there is shock, what does response does that activate?
What med could you give?
What would you use to counteract it?
Inflammatory response
- you could give a steroid as an BUT understand that it can raise blood glucose even higher
- You would need to hang an _insulin dri_p then.
What is MODS?
Multi-organ failure (death). Shock can cause it & if it gets to this point, its over.
What is common to all shock states?
Inadequate O2 delivery to meet cellular oxygen demand
- not “decreased”.
Explain the pathophysiology of shock with this:
Not enough o2 > Anaerobic metabolism > Acidotic body > Na-K malfunction > call structures damaged > cell death
Not enough 02 tissue perfusion is occurring. This causes the cells to go through necrosis which causes acidosis. At this point, it is reversible if we intervene. The body will try to support a dropping BP by vasoconstriction. If this goes on, you will have MODS due to hypoxemia and metabolic acidosis.
Common occurrences with shock/MODS
Respiratory failure
Renal failure
Decreased Cerebral perfusion
Disseminated Intravascular Coagulation (blood clotting)
What causes the vasodilation/vasoconstriction changes in the body on the cellular level?
List some…
Cytokines - they do this based off the body’s needs for compensation due to the body’s neural, chemical, and hormonal aspects working together to keep the body perfused
- interferon, interleukin, growth factors
Three classifications of shock states
- Cardiogenic shock of the heart
- Hypovolemic shock rt third spacing
- Distributive-abnormal placement
Most common form of cardiogenic shock?
Left ventricular failure shock rt myocardial infarction
What is hypovolemic shock?
Decreased tissue perfusion due to a lack of intravascular volume (state of being hypovolemic or dry)
What does hypovolemic shock result from? (2)
- A decrease of fluid in your circulation (maybe you lost blood from trauma)
- Internal fluid shifts are going on (dehydration, edema, ascites)
Explain the hypovolemic shock relationship with the heart affects blood pressure?
Due to a decrease of volume of some sort, the right atrium is not perfused which affects the whole heart and reduces CO and therefore reduces the BP.
Hypovolemia related to Fluid Shift example
Hemorrhage
Burns (due to 3rd spacing & drainage)
Ascites
Peritonitis (inflamed peritoneal)
Dehydration
Hypovolemia related to Fluid Losses examples
Trauma
Surgery
Vomiting
Diarrhea
Diuresis
Diabetes insipidus
How is diabetes inspidus fluid loss able to cause hypovolemic shock?
Due to the ADH hormone. Diabetes insipidus = less ADH = more peeing so fluid is lost
How exactly does less blood volume in hypovolemic shock cause less oxygen to be transported?
What will we be checking?
Less blood means less hemoglobin for oxygen to hope on to to get to the tissue!
We will be checking H&H labs, RBC, and O2 sats.
How can hypovolemic shock lead to carbon monoxide toxicity (transport shock state)?
Due to not being able to bring oxygen to the tissue, the tissue is unable to get rid of the CO2 waste as well
(this process is gas exchange)
How can hypovolemic shock lead to anemia (transport shock state)?
What about hemorrhage?
The decrease in H&H and MCV - size of rbcs.
Hemorrhage results in a loss of fluid from the body completely
What is cardiogenic shock?
Impaired oxygen delivery to the rest of your body due to the cardiac dysfunction
- don’t confuse this with hypovolemic shock simply causing the heart to lower BP. It is different
How does MI cause cariogenic shock?
If you have an MI, anterior especially, your heart stops working and the rest of your body experience shock
What mechanical complications of the heart can lead to cariogenic shock?
valve stenosis and regurgitation
Again, these issues cause the rest of your body to go into shock
How can cardiomyopathy cause cardiogenic shock?
Cardiomyopathy is a hereditary disease of the heart which affects the hearts ability to pump out blood to the body - which can lead to shock.
How can a myocardial contusion cause cariogenic shock?
Contusion is bruising of the heart so it affects perfusion to the rest of the body
How can pericardial tamponade cause cardiogenic shock?
What will you notice on assessment?
Fluid surrounds the heart so there’s a decrease in room for it to contract & therefore less perfusion
heart sounds will sound distant and muffled
How can ventricular rupture cause cardiogenic shock?
Ventricular rupture means blood is being lost through the ventricles and without the ventricles, you can’t perfuse the body
How can arrhthymias cause cardiogenic shock
A.fib and A. flutter decrease the amount of blood being perfused to the rest of the body
How can end stage HF cause cardiogenic shock?
The ejection fraction could be so low it can’t perfuse the body. (norm is 50-70%).
Populations that are most vulnerable to cardiogenic shock?
Elderly
Diabetics - their vascular is brittle and stenosed
Anterior MI - descending coronary artery
History of MI
T/F
Ventilated patients are safe from cardiogenic shock
False!
The ventilation settings affect heart contractility - which can in turn cause the cardiogenic shock.