shock Flashcards
shock is
inadequate tissue perfusion. A clinical state of acute circulatory failure with inadequate oxygen utilization and/or delivery to the cells resulting in cellular hypoxia”
is shock reversible
Initially reversible if treatment provided rapidly to prevent
progression to irreversible organ dysfunction.
what happen during compensatory phase
the body attempts to maintain
perfusion using its available compensation mechanisms
during decompensation phase what happen
During decompensation phase, body is unable to keep up
with demands
what is fick principle
- On-loading of O2 to RBC in the lung
- Delivery of RBC to tissue cells
- Off-Loading of O2 from RBC to tissue cells
Factors that can affect oxygen delivery to the tissues:
- Cardiac Output 2. Available Hemoglobin 3.Oxygen Saturation (SpO2)
Things that can adversely effect oxygen delivery:
- Hypoxia
- Inadequate circulation
- Inadequate transport medium (e.g., hemoglobin) * Cellular toxins
Organ Tolerance to Ischemia
HEART , BRAIN , LUNG -> 4-6min
❑ KIDNEY,LIVER,GI TRACT -> 45-90min
❑ MUSCLE, BONE, SKIN -> 4-6 hours
T/F A patient with signs of compensation is already in
shock, not “going into shock”
T
next stage after decompensated shock
death
shock progression
Compensatory defenses work well to a point…
❑ When defense mechanisms can no longer overcome volume reduction, …BP
going into DECOMPENSATION
what is hypovolemic shock
educed intravascular volume * May occur with acute blood volume loss due to
dehydration (loss of plasma)
* Hemorrhage (loss plasma + RBC), upsets the relationship of fluid volume to size of container balance.
what are the 2 types of hypovolemic shock
Absolute Hypovolemia (hemorrhagic cause)
Relative Hypovolemia (non-hemorrhagic causes)
eg: GI losses, skin losses, renal losses third-space losses (shifting of fluid into interstitial space)
how hypovolemic shock occurs with blood loss
- Heart stimulated Cardiac Output through release of epinephrine from adrenal glands
- Sympathetic system releases norepinephrine to blood vessel size (to reduce container size)
- This closes peripheral capillaries leading to anaerobic metabolism at cellular level
what is distributive shock
Vascular container enlarges without proportional increase in fluid volume
* Relatively less fluid will be available for size of container.
* The amount of fluid available to the heart as preload decreases
and cardiac output falls.
how does distributive shock occurs
Resistance to flow is decreased because of vessel size leading to diastolic BP. Net effect is systolic & diastolic BPs
neurogenic distributive shock occurs when
Can occur when a cervical spine injury damages the spinal cord above where the nerves of the sympathetic nervous system exit.
* Because of loss of sympathetic control vessels dilate below level of injury.
difference btw neurogenic shock and spinal shock
neuro:Disruption of sympathetic nervous system leading to dilation peripheral arteries
(↓BP, pulse normal-slow, warm dry skin below level, alert oriented, no reflexes)
spina :lnjury to the spinal cord that results in temporary loss of sensory and motor function
can spinal and neurogenic shock occurs at the same time
yes
what is septic chock
Cytokines, which are locally active hormones
produced by WBC responding to infection cause damage to the wall of the blood vessels, causing peripheral vasodilation and a leakage of fluid from the capillaries into the interstitial space.
what is psychogenic shock
Mediated through parasympathetic
Nervous system… vagal nerve stimulation produces bradycardia. Can also lead to transient peripheral vasodilation and hypotension. If severe enough: Cardiac output and then vasovagal syncope
type of obstructive shock
mechanical
pericardial tamponade
tension pneumothorax
stage of shock
Pre-shock (compensated)
The body’s compensatory mechanisms are able to maintain
some degree of tissue perfusion.
- Shock (decompensated)
The body’s compensatory mechanisms fail to maintain tissue perfusion (blood pressure falls). - End-organ dysfunction (irreversible)
Tissue and cellular damage is so massive that the organism dies even if perfusion is restored
As compensatory mechanisms fully engage, what signs and symptoms would you expect to see?
- Tachycardia
- Tachypnea
- Pupillary dilation
- Decreased capillary refill * Pale cool skin
When compensatory mechanisms fail, what signs and symptoms would you expect to see?
- Hypotension
- Falling SpO2
- Bradycardia
- Loss of consciousness * Dysrhythmias
- Death
pulse, skin BP, LOC in compensated shock
increased, tachy
white, cool, moist
normal
unaltered
pulse, skin BP, LOC in decompensated shock
marked increased marked tachy
can progress to brady
white, cold, waxy
decreased
altered from disoriented to coma
shock complication
Acute Respiratory Distress Syndrome (lung lining damage) ❑Acute Renal Failure (ischemic reaction)
❑ Hematologic Failure (coagulopathy)
❑ Hepatic Failure (liver ischemic reaction)
❑ Multiple Organ Failure
❑ Failure of 1 major body system
leg: lungs, kidneys, blood clotting, liver)
associated with mortality of 40%.
first symptom you would except to find for shock
increase respiratory rate
increase heart rate
Second most common physiological response to the development of shock? plus symptom
“Peripheral vasoconstriction”
* Pale skin * Cool skin * Weakened peripheral pulse, flat neck veins
As shock progresses – what physiological effects are seen?
- End-organ perfusion falls
What symptoms would you expect to see? * Altered mental status - Decreased urine output (ER)
s/s progression of shock
Mild anxiety→confusion/altered LOC
* Mild tachypnea → rapid laboured ventilations * Mild tachycardia →marked tachycardia
* Weakened radial pulse → absent radial pulse * Pale or cyanotic skin color
* Capillary refilling time > 2 seconds
with which type of shock you would have a lucid LOC
neurogenic
with which type of shock you would have a normal cap refil
neurogenic
in which type of shock skin temp is warm and dry
neurogenic
in which type of shock skin color is pale,cyanotic
cardiogenic and hypovolemic
n which type of shock skin color is pale and mottled
septic
n which type of shock skin color is pink
neurogenic
during shock you need to have a SpO2 of at least
94%
in shock if not breathing adequately which device you use
BVM even if breathing
how do you transport patient in shock
Trauma patients in shock should be transported supine & neutral unless otherwise indicated
effect of elevation of feet in patient in shock
May aggravate impaired ventilatory function by placing weight of abdominal organs on the diaphragm.
* May increase intracranial pressure with traumatic brain injury
* Patients in severe hypovolemic shock don’t get significant autotransfusion of blood to the vital organs from the extremities.
* Both Trendelenburg and shock positions contraindicated with suspected spine injury
