SHOCK Flashcards
is a life-threatening condition that occurs when the
body is not getting enough blood flow.
➢ Affects all body systems
SHOCK
The cell swells and the cell membrane becomes more
permeable, and fluids and electrolytes seep from and
into the cell. Mitochondria and lysosomes are
damaged, and the cell dies
Cellular Effects of Shock
Compensatory stage of shock
Blood pressure norm
Vasoconsriction
HR normal
Fight or flight respone
Skin cold and clammy
Decrease ADH
In the progressive stage of shock, the mechanisms
that regulate blood pressure can no longer
compensate and the MAP falls below normal limits,
with an average systolic blood pressure of less than
90 mm Hg.
PROGRESSIVE
The irreversible (or refractory) stage of shock
represents the point along the shock continuum at
which organ damage is so severe that the patient
does not respond to treatmen
IRREVERSIBLE
can occur as a progression
along the shock continuum or as a syndrome unto
itself
Multiple organ dysfunction
Overall Management Strategies in Shock
FVN
Fluid replacement
Vasoactive medications
Nutritional support
to restore
vasomotor tone and improve cardiac function
Vasoactive medications
to address the
metabolic requirements that are often
dramatically increased in shock
Nutritional support
are administered in all forms
of shock to improve the patient’s hemodynamic
stability when fluid therapy alone cannot maintain
adequate MAP.
VASOACTIVE MEDICATION THERAPY
occurs when there is a reduction
in intravascular volume of 15% to 25%. This would
represent a loss of 750 to 1,300 mL of blood in a
70-kg (154-lb) person.
Hypovolemic shock
MEDICAL MANAGEMENT
Hypovolemic shock
restore intravascular volume to reverse the sequence
of events leading to inadequate tissue perfusion
2. redistribute fluid volume
3. correct the underlying cause of the fluid loss as
quickly as possible
Proper positioning (modified Trendelenburg)
What to remember for hpovol shock for crystalloid solution?
Remember the 3:1 rule for crystalloid solutions: For
every 1 mL of approximate blood loss, 3 mL of crystalloid
solution is given
occurs when the heart’s ability to
contract and to pump blood is impaired and the
supply of oxygen is inadequate for the heart and
tissues
CARDIOGENIC SHOCK
The causes of cardiogenic shock are known
as either
coronary or non-coronary.
seen most often in
patients with
myocardial infarction
occurs when a
significant amount of
the left ventricular
myocardium has been
destroyed
CORONARY
causes can be related to
metabolic problems and tension
pneumothorax
NON-CORONARY
INITIATION OF FIRST-LINE TREATMENT
First-line treatment of cardiogenic shock involves the following
actions:
Supplying supplemental oxygen
● Controlling chest pain
● Providing selected fluid support
● Administering vasoactive medications
Caused by a mechanical obstruction that prevents an
adequate volume of blood from filling the heart
chambers
OBSTRUCTIVE SHOCK
Obstructive Shock: Management
Control airway
● Intubation
● Treat the underlying cause
results from a maldistribution or mismatch of blood
flow to the cells.
➢ shock state resulting from displacement of blood
volume creating a relative hypovolemia
CIRCULATORY OR DISTRIBUTIVE SHOCK
Fluid replacement must be instituted to correct the
hypovolemia
Crystalloids, colloids, and blood products may be
administered to increase the intravascular volume
Classification of Circulatory shock
- Septic shock
- Neurogenic shock
- Anaphylactic shock
The disorder is thought to be a response to that
release microbes or immune mediators, such as
tumor necrosis factor and interleukin- 1.
occurs due to sepsis and leads to a
major decrease in tissue perfusion to organs and
tissues.
Septic shock
Resuscitation goals include:
- MAP more than 65 mmHg
- Target CVP of 8-12 mmHg (12-15 mmHg if
ventilated) - Central venous O2 saturation (ScvO2) equal or
more than 70%
results in massive
vasodilation and a decrease in peripheral vascular
resistance, causing blood to pool in the venous
system.
This loss of sympathetic tone
occurs rapidly and is
life-threatening.
ANAPHYLACTIC SHOCK
Medical Management
ANAPHYLACTIC SHOCK
Removing the causative antigen, administering
medications that restore vascular tone, and providing
emergency support of basic life functions.
● Epinephrine is given for its vasoconstrictive action.
Any pathogenic organism can cause septic shock.
❖Gram-negative bacteria, such as E
Escherichia coli,
Klebsiella pneumoniae, Serratia, Enterobacter, and
Pseudomonas rank as the most common causes and
account for up to 70% of all cases
