Shock

Question 1

What is shock?

Answer 1

1. Circulatory system is unable to provide adequate circulation and tissue perfusion
2. leads to failure to deliver O2 to vital organs

3.cellular hypoxia occurs + energy deficit

Question 2

Why is oxygen important in cells

Answer 2

Cells require O2 to produce energy and maintain life

Question 3

What does decreased tissue perfusion lead to?

Answer 3

1.Hemorrhage
2.Hypovelmia
3.Cardiac failure
4.Neurological injury

Question 4

What is Hypovolemic shock?

Answer 4

Circulatory failure due to volume loss (blood/fluids)

caused by hemorrhage, dehydration or plasma loss (burns, trauma)

Question 5

What is Cardiogenic Shock

Answer 5

Shock that occurs when the heart is unable to pump enough blood to meet the bodies demands

caused by heart problems: MI, heart failure, dysrhythmias, etc

Question 6

What is obstructive shock?

Answer 6

Shock caused by a condition that prevents oxygen from getting to organs/tissue

caused by clots, collapsed lungs, aortic dissection, cardiac compression (pericarditis/ tamponade)

Question 7

What are the 4 Disruptive shocks?

Answer 7

Septic
Anaphylactic
Neurogenic
Psychogenic

Question 8

What is septic shock?

Answer 8

Shock caused by an infection dropping blood pressure to a dangerous level

Question 9

What is Anaphylactic shock?

Answer 9

Also known as Anaphylaxis, is shock caused by a severe reaction to an allergen, leading to a drop in BP, airway tightening

Question 10

What is neurogenic shock?

Answer 10

Shock caused by injury to the spinal cord.
manifests with hypotension, bradyarrhythmia’s, temperature dysregulation and vasodilation.

Question 11

What is psychogenic shock?

Answer 11

Shock caused by stress, pain or fright.

HR drops and vessels dilate leading to hypo perfusion in the brain and eventually loss of consciousness.

Question 12

What is compensatory shock (stage 1)?

Answer 12

Acute blood loss of 10 - 15 % of normal blood volume

Activation of sympathetic nervous system - can be reversed through the bodies compensatory mechanism

Question 13

Signs and symptoms of compensatory shock (stage 1)?

Answer 13

BP maintains
BP declines when patient stands up
Increase in HR
Paleness
Anxiety

Question 14

What is progressive shock (stage 2)?

Answer 14

Acute blood loss of 20 - 40%of normal blood volume

Massive activation of parasympathetic nervous systems - compensatory mechanisms kick in

Question 15

Signs and symptoms of progressive shock (stage 2)?

Answer 15

Systolic BP drops 10-20
Tachycardia
Skin pale and cool
Decreasing LOA
Thirst
Decreased urine output
Angina may occur

Question 16

What is irreversible shock (stage 3)?

Answer 16

Acute loss of >40% of normal blood volume

Leads to irreversible tissue damage to the heart, brain and kidneys - can lead to death

Question 17

Signs and symptoms of irreversible shock (stage 3)?

Answer 17

Unconsciousness
severe hypotension
decreasing heart rate

Question 18

What is neurogenic compensation?

Answer 18

Fight or flight response (sympathetic nervous system)
-Vasoconstriction
-Increased HR
-Preferential perfusion to brain and heart

Question 19

What is chemical compensation?
When does it occur?

Answer 19

Occurs after 30 minutes

Decreased cardiac output + Increased O2 tissue perfusion = decreased PaO2. This activates chemoreceptors to stimulate the respiratory system into respiratory alkalosis .

This can lead to cerebral ischemia, cerebral vessel constriction and decreasing LOA

Question 20

What is hormonal compensation?

Answer 20

Can occur when impulses from the sympathetic nervous system occur:

1. adrenal medulla releases epi / norepi (potent vasoconstrictors)
2. decreased blood flow to kidneys activates the Renin-Angiotensin system
3. hypothalamus stimulates posterior pituitary gland, leading to release of hormones that influence metabolism of macronutrients.

Question 21

What two processes are aimed to be restored when initiating shock therapy?

Answer 21

Cellular perfusion

Oxygenation