Shock Flashcards
What conditions can cause non blood fluid loss?
Severe burns
D&V
Bowel obstruction
Acute pancreatitis
D.K.A
Anaphylaxis
Severe dehydration
How can DKA cause hypovolaemic shock?
An increase in glucose can cause the kidney transport maximum to be exceeded causing excess glucose and water to be lost in urine
How can bowel obstructions cause hypovolaemic shock?
Absorption activity is effected
- Intestinal lymphangiectasia (dilation and leaking of lymph vessels)
- Direct pressure causes oedema to surrounding tissues from vessels and reduced drainage from lymphatic vessels
- Hyperactivity of bacteria cause inflammation and damage to the mucosa affecting its ability to absorb water
Fluid is pulled from the body into the GI tract via enterocutaneous fistula ‘third space’
How can acute pancreatitis cause hypovolaemic shock?
Pancreatic protease become undesirably active and start digesting the pancreatic tissue, as a result lots of pancreatic fluid gets leaked out into the abdominal cavity
How are the kidneys involved in hypovolaemic shock?
Kidneys are involved in fluid loss/retention and a decreased BP can stimulate the kidneys’ RAAS.
What is cardiogenic shock?
Hypoperfusion caused by reduced cardiac output
How does shock cause cell death?
What are the four stages of shock?
Initial
Compensatory
Progressive
Refractory
How does pulse change throughout shock?
Initial raise, eventual drop/widening pulse pressure
How do respirations progress throughout shock?
Initially increase, eventually drop/become irregular
What treatment is important to give to hypovolaemic shock patients?
Control of blood/fluid loss where possible whilst maintaining other vitals such as:
Blood pressure, respirations, O2 levels and body temperature
What kind of things can cause cardiogenic shock?
Myocarditis
MI
Arrrythmias
-Electrocution
Congenital heart diseases
Valve damage/disfunction
What treatment is important for cardiogenic shock?
General shock treatment while tackling cardiogenic issues to increase CO.
How can a proximal aortic dissection cause reduced cardiac output?
By placing increased pressure back on the heart affecting filling and ejection.
What is dissasociative blood shock?
Inability of the blood to carry oxygen to the tissues
What can cause dissasociative blood shock?
Poisonings (carbon monoxide, nitrate, cyanide)
Anaemia
Asphyxia
What is anaphylactic shock?
Systemic histamine action and fluid shift
What is psychogenic shock?
Temporary loss of circulating blood to the brain
What can cause phychogenic shock?
Fainting/Loss of consciousness caused by
Fear
Emotional trauma
Anxiety.
What is obstructive shock?
A physical obstruction inside the heart or major vessels
What does renin cause?
Renin causes vasoconstriction and is also converted into angiotensinogen I then angiotensinogen II
What does the production of angiotensinogen I & II cause?
It triggers aldosterone to be produced by the adrenal gland and ADH being produced by the pituitary gland.
What does aldosterone cause?
Increased sodium and water reabsorption
What happens during the initial stage of shock?
Cardiac output decreased, perfusion compromised
What happens during the compensatory phase of shock?
The body’s homeostatic mechanisms attempt to maintain cardiac output, blood pressure, and tissue perfusion
What happens during the progressive stage of shock?
The compensatory mechanisms begin failing to meet tissue metabolic needs, and the shock cycle is perpetuated.
What happens during the refractory stage of shock?
Shock becomes unresponsive to therapy and is considered irreversible
What is dilutional coagulopathy
Dilutional coagulopathy is usually defined as loss, consumption, or dilution of coagulation factors and occurs when blood is replaced with fluids that do not contain adequate coagulation factors
