shock

Question 1

Define shock and distinguish between the different types of shock

Answer 1

it is the failure to maintain adequate tissue perfusion which results in cellular dysfunction due to lack of 02

• Decrease in ATP which leads to sodium potassium pump failure which affects membrane potentials
• Anaerobic respiration which leads to Increase lactic acid which leads to Metabolic acidosis

Decreased nutrients

• Gluconeogenesis which stimulates protein catabolism which causes decreased serum protein and azotemia. Decreased serum protein decreases capillary osmotic which increases capillary permeability which leads to hypovolemia
• Increased lipolysis which leads to hyperlipidemia and an increase in ketones which lead to ketoacidosis

Question 2

obstructive shock

Answer 2

Obstruction in the great vessels e.g. pulmonary embolism which causes a decrease in cardiac output

Find the obstruction

Signs and symptoms

• Pulmonary oedema
• Hypotension
• Oliguria
• Shortness of breath
• Cool, clammy skin

Question 3

hypovolemic shock

Answer 3

Decreased blood volume due to

• Haemorrhage
• Dehydration
• Burns

Phase 1: initial drop in blood volume and drop in vital signs

Phase 2: activation of RAAS and Sympathetic nervous system which increases heart rate and respiratory rate, sweating, increase in blood pressure, decrease in urination, pale peripheries

Phase 3: failure of RAAS and SNS to adequately restore tissue perfusion so heart rate and respiratory rate are still up but blood pressure and pulse drop which causes cold, clammy, confusion, irritation, no urination

Phase 4: organ failure occurs and is irreversible which causes loss of consciousness and non detectable vital signs

Treatment is fluid resuscitation

Question 4

neurogenic shock (vasogenic shock)

Answer 4

Increase in PSNS (parasympathetic nervous system) and decreased decreased SNS (sympathetic nervous system) which leads to widespread vasodilation which causes a drop in TPR and a drop in BP, decreased heart rate which means decreased CO which means decreased BP

Caused by

• Brainstem injury
• Spinal cord injury
• Certain medications

Signs and symptoms

• Hypotension
• Bradycardia

Treatment

• Vasopressors
• Fluid management

Question 5

anaphylactic shock

Answer 5

Certain allergens stimulate a hypersensitivity reaction which creates a humoral immune response which causes a rise in mast cells, basophils and IgE which cause inflammation and vasoactivity which causes widespread vasodilation. This decreases TPR which lowers blood pressure

Signs and symptoms

• Hypotension
• Tachycardia (increase heart rate)
• Swelling and oedema which can lead to respiratory difficulty
• Hives
• Itching
• Anxiety
• Headache

Treatment

• Remove allergen
• Intramuscular adrenaline
• Fluid management

Question 6

septic shock and cardiogenic shock

Answer 6

septic
Inflammatory response to an infectious microbe in the blood. The response leads to widespread vasodilation

cardiogenic
Cardiac problem with the heart which leads to decreased cardiac output
Problem with the pump
Figure out what the problem is, manage cardiac workload