Shock Flashcards
Shock
the inability of the heart and lungs to satisfy the metabolic and oxygen needs of the peripheral tissues
What do all types of shock lead to
cellular hypoxia, anaerobic metabolism, lactic acidosis
Initial stage of shock
Sudden drop in bp and tissue perfusion that triggers the SNS and RAAS
Stages of shock
Initial, progressive, irreversible
S/S of the initial stage of shock
anxious, pale, cold and clammy extremities
When is medical intervention for shock decided
during the initial stage when compensatory mechanisms are not enough to stabilize bp
Progressive stage of shock
the lungs, kidney, gut, pancreas, and liver experience decreased perfusion, there is waste/toxin accumulation, no peristalsis
S/S of progressive stage of shock
multiple organ dysfunction
Where is the small amount of available blood conserved for during the progressive stage of shock
heart and brain
Irreversible stage of shock
myocardial and cerebral ischemia with widespread cellular hypoxia
What happens on the cellular level of the irreversible stage of shock (6)
anaerobic metabolism uses glucose to produce energy and lactic acid, energy stores are depleted, mitochondria cannot make ATP, lactic acid builds up in the bloodstream, organelles fail, digestive enzymes are released to breakdown cellular debris
Universal signs of shock
tachypnea, tachycardia, cyanosis, metabolic acidosis, metal status change, low urine output, ECG changes, changes in CO/CVP/TPR
Signs of generalized inflammation in shock
fever, increased HR, rapid RR, low BP
Types of shock
cardiogenic, hypovolemic, anaphylactic, neurogenic, septic
Cardiogenic shock
severe hypotension, significant decrease in aortic perfusion, loss of circulation in systemic arteries –> low urinary output, peripheral cyanosis, altered mental status
Cardiogenic shock causes
acute MI, cardiac tamponade, severe tachycardia, bradyarrhythmias
What is treated in cardiogenic shock
reduce heart’s oxygen needs, support CO, perfusion to myocardium
Treatment options for cardiogenic shock
meds, angioplasty, stent, CABG, Intra-aortic balloon pump
Cardiac tamponade
occurs when there is an increased amount of fluid in the pericardial effusion
Hypovolemic shock
the amount of blood in the body’s vascular system is reduced, reducing coronary artery blood flow, BP, and aortic volume
What is hypovolemic shock usually caused by
extensive loss of blood in hemorrhage, loss of ECF through diarrhea/vomiting/ascites/severe burns, insufficient venous return
Treatment of cardiogenic shock
rapid fluid replacement, stop fluid loss
Anaphylactic shock
extreme manifestation of an allergic reaction, histamine is released causes vasodilation, increases capillary permeability –> hyperperfusion and hypotension
Treatment of anaphylactic shock
epinephrine, antihistamines, glucocorticoids, IV saline due to large fluid shift from bloodstream to tissues, intubation if bronchoconstriction is severe, identify antigen and carry epipen
Neurogenic shock
the SNS is disrupted by a spinal cord/brain injury that causes widespread vasodilation and reduced venous return –> reduces CO and hypotension
When does a lack of sympathetic tone and the parasympathetic nervous system action occur
during spinal cord injury to upper thoracic region or higher
Treatment of neurogenic shock
IV vasoconstrictors, fluid administration, atropine to counteract parasympathetic bradycardia, treat CNS injury
Septic shock
a severe state of sepsis, body-wide infection, with persistent hypotension
What accumulates during septic shock and what does it cause
toxins and inflammation creating capillary permeability, coagulation pathways, and hyperglycemia
Treatment of septic shock
appropriate antibiotics, CO support, vasoconstrictors, respiratory support, possible surgery to remove infection, dialysis
What type of shock is the most complex to treat and involves multiple specialists
septic shock
What type of shock is most likely in immunocompromised patients
septic shock
