Shock

Question 1

What are the chances of dying from shock?

How do you prevent it?

Answer 1

10% to 100% chance

prevent= prophylactic treatment

Question 2

Significance of shock

It is a life threatening condition–

Answer 2

affects all body systems
organs struggle to survive
often develops rapidly (depending on the cause)

Question 3

what is shock caused by

Answer 3

nonspecific “assault” to the body
infectious or noninfectious
– hence all patients are at risk for shock

Question 4

what is the best treatment of shock

Answer 4

prevention

Question 5

what can early recognition do

Answer 5

save lives

Question 6

Shock

the condition itself:

Answer 6

a state of hypoperfusion

Question 7

a state of hypoperfusion =>

Answer 7

O2 debt: decreased O2 supply

Acidosis: poor removal of metabolites and toxins at the cellular level

Question 8

body’s response to shock

Answer 8

stimulation of ANS sympathetic pathway

Question 9

Body’s response: stimulation of ANS sympathetic pathway

Answer 9

hypermetabolism=> increase demand

• worsening o2 debt => anerobic metabolism => lactic acidosis
• peripheral insulin resistance, later systemic and ketoacidosis

inflammatory response=> SIRS, hypercoagulability

Question 10

SIRS

systemic inflammatory response syndrome =>

Answer 10

response to nonspecific assult=> 
Ischemia
Inflammation
Trauma
Infection

Question 11

criteria for SIRS (2 or more)

Answer 11

Temp >100.4 or <96.4
HR >90
RR >20
PaCO2 < 32 (35-45 mmHg)
WBC >12000, <4000, >10% band
Lactate level >2 mmol/L
SBP < 90 after fluid bolus test

Question 12

Components of perfusion

Answer 12

Circulating Volume:
Fluid volume status
Preload

Pump: 
contractility
valve function
HR
pre/after-load
rhythm

Vascular System:
Vascular integrity
tone
resistance

Question 13

Types of shock

Answer 13

Hypovolemic Shock

Cardiogenic Shock

Obstructive Shock

Circulatory Shock

• Septic
• Neurogenic
• Anaphylactic

Question 14

Hemodynamic MonitoringHow to monitor when all you have at the bedside is BP!

Answer 14

MAP = (SBP+ 2DBP) / 3
MAP must be > 65 to provide adequate perfusion

PP: measure of stroke volume and vascular resistance
PP= SBP – DBP (30-40)
Narrow (↓)PP = early poor perfusion (vasoconstriction = higher DBP)
Wide (↑) PP = late poor perfusion (vasodilation = lower DBP)

Question 15

Timely recognition shock is difficult!

Answer 15

No definitive S&S

Each patient presents differently

Early clinical manifestations may go unrecognized

• can be very apparent (massive external hemorrhage)
• can be silent (compensatory phase of septic shock)

Question 16

Stages of Shock

Answer 16

Stage I: “Compensatory stage”
compensatory responses stabilize the perfusion, preventing further deterioration

Stage II: “Progressive stage”
clear signs of hypoperfusion and organ dysfunction

Stage III: “Irreversible stage” (refractory)
Massive cellular destruction results inevitably in death