Shock Flashcards
What is shock?
decreased tissue perfusion and impaired cellular metabolism that affects ALL body systems
What are the two classifications of shock and what does it consist of?
- Low blood flow
- cardiogenic, hypovolemia - maldistribution (circulatory/distributive)
- neurogenic, anaphylactic, septic
What is cardiogenic shock?
Ineffective cardiac pump
Caused by coronary(MI) or non coronary (hypoxemia)
What are the signs and symptoms of cardiogenic shock?
Tachycardia, hypotension, pallor; cool, pale, clammy skin, decrease cap refill, anxiety, agitation , decreased renal perfusion
How do you treat cardiogenic shock?
Restore blood flow to the myocardium by restoring the balance between O2 supply and demand
- Oxygen therapy, control chest pain, IV therapy…
What is hypovolemic shock?
Blood volume deficit
Caused by loss of intravascular fluid
What are the signs and symptoms of hypovolemic shock?
anxiety, tachypnea, increased heart rate, decrease urinary volume
How do you treat hypovolemic shock?
Stopping the loss of fluid and restoring the circulating volume. Administering prescribed fluids, drugs, and oxygen if needed
Why would you put someone who is in hypovolemic shock into modified trendelenburg?
increase cardiac output and circulation to the heart as well as to improve blood flow to the vital organs
What is neurogenic shock?
Shock due to a spinal cord injury at the fifth thoracic (T5) vertebra or above leading to massive vasodilation
What are the signs and symptoms of neurogenic shock?
Bradycardia, dry skin, hypotension, temperature dysreguation
What is the treatment of neurogenic shock?
Spinal stability
- treatment for hypotension and bradycardia
- monitor for hypothermia
What is an anaphylactic shock?
life threatening, allergic reaction
What are the signs and symptoms of anaphylactic shock?
chest pain, wheezing, swelling, anxiety, incontinence, flushing, respiratory distress, hives(urticaria)
What is the treatment of anaphylactic shock?
Medication: epinephrine, diphenhydramine, corticosteroids
Maintain a patent airway: bronchodilators, endotracheal intubation
Fluid replacement
What is septic shock?
Serious, caused by widespread infection. Presence of sepsis
What is sepsis?
systemic inflammatory response to documented or suspected infection
What are the signs and symptoms of septic shock?
tachypnea/hyperventilation, temperature regulation, decrease urine output and fibrinolysis, GI dysfunction, increased coagulation and inflammation
What is the treatment of septic shock?
Medication: Antibiotics AFTER cultures are obtained
–> Drotrecogin alfa(Xigris): Major side effect is bleeding
Fluid replacement: Restore perfusion
Vasopressor drug therapy
IV corticosteroids: Maintain adequate BP
How does multiple organ dysfunction system connect to septic shock?
Phase of progression of shock
What are the four stages of shock?
- Initial Stage
- Compensatory stage
- Progression stage
- Refractory (irreversible) stage
What is the initial stage of shock?
- Usually not clinically apparent
- Metabolism changes from aerobic to anaerobic
–> lactic acid accumulates and must be removed by blood and broken down may liver
What is the compensatory stage of shock?
- Clinically apparent
- Body activates neutral, hormonal, and biochemical compensatory mechanisms
What are the signs and symptoms of the compensatory stage of shock?
- Fight or flight response
–> body starts to shut down, blood goes to heart and brain. Decrease urine output, hypoactive bowel sounds - cool clammy skin
- decreased BP, increase HR
- can be corrected, pt recovers with no residual affects
What is the progressive stage of shock?
- If compensatory mechanisms fail
- aggressive interventions to prevent multiple organ dysfunction syndrome
- decreased cellular perfusion and altered cap permeability
-anasarca happens
What is anasarca?
- Fluid leakage affects solid organs and peripheral tissues and decreased blood flow to pulmonary capillaries
What are the sign and symptoms of progressive stage of shock?
- Fluid moves from pulmonary vasculature to interstitial, alveoli (pulmonary edema, bronchoconstriction, decrease residual capacity)
- CO begins to fail causing hypotension, weak pulses, schema, and decreased peripheral perfusion
- myocardial dysfunction (end result of complete deterioration of cardiovascular system)
- Mucosal barrier of GI system becomes ischemic (ulcer, bleeding)
- Liver fails to metabolize drugs and waste (Jaundice, elevated enzymes, loss of immune function, risk for DIC and significant bleeding)
What is irreversible stage of shock?
- Organ damage is so severe that the patient does not respond to treatment and cannot survive
- Recovery unlikely
- Failure of one organ affecting others
What are the diagnostic studies of shock?
- No SINGLE study to determine shock
- Thorough hx and physical examination
- Blood studies (elevated lactate, base deficit)
- 12-lead ECG
- Chest x-ray
- Hemodynamic monitoring
What are management strategies in shock?
- Early identification and timely treatment is KEY
- Management and care of the pt will vary
Treatment for shock?
Correction of decreased tissue perfusion and nutrition
- Must focus on ABC (airways, breathings, and circulation)
How do you prevent a patient into septic shock?
hand hygiene
antibiotics
If someone has low blood pressure, how would you get it back to normal?
trendelenburg position
Increase IV bolus
What is circulatory shock?
What is the sighs and symptoms of circulatory shock?
What is the treatment of circulatory shock?
