Shock Flashcards
What is shock?
A lack of tissue perfusion (oxygenation) that leads to anaerobic metabolism
What is Cardiogenic shock?
Shock caused by the heart stopping functioning properly
What is Obstructive shock?
Something blocks blood from pumping through the heart even if the heart is working normally (e.g. embolus, air, etc)
What is Hypovolemic shock? What are the 5 types?
Hypovolemic is a general term related to an insufficient amount of blood circulating in the system. Divided into true and relative
i. Hemorrhagic - nervous system loses a large quantity of blood
ii. Neurogenic - nervous system loses the ability to control the constriction of blood vessels
iii. Psychogenic - body’s blood vessels dilate due to stress
iv. Septic - Infections release toxins into the blood, causing BV to dilate
v. Anaphylactic - increases permeability of BV, allowing fluid to leak out of the circulatory system, reducing volume.
Anaphylactic and hemorrhagic are true hypovolemic shock. Others are relative
What are the 4 stages of shock? From normal state onwards
Normal function
Compensated shock
Decompensated shock
Irreversible shock
What is compensated shock?
The body’s first attempt to maintain homeostasis. Body detects that perfusion is low and attempts to restore normal circulation. BV constrict, focusing blood to vital organs
What is decompensated shock?
IF the compensatory mechanisms are unsuccessful, body’s tissues start to become hypoxic
At this stage shock becomes life-threatening but can be reversed with intervention.
What is irreversible shock?
At this stage the body’s vascular system is unable to maintain its internal pressure. Blood pools in extremities away from vital organs
If patient reaches this stage they will not survive regardless of intervention
What are the (abbreviated) steps of shock for a hemorrhagic shock patient from normal function to irreversible shock?
- Injury causes hemorrhage
- Heart attempts to compensate by beating faster
- This causes higher oxygen demand - RR increases as result
- BV in extremities constrict to maintain blood around organs
Decompensated - Extremities begin to become hypoxic and die. Brain responds by restoring oxygen to extremities in an attempt to balance oxygen needs across body.
- Vital organs now lack adequate oxygen. HR goes faster to try and compensate.
Irreversible - Without sufficient oxygen, vital organs begin to stop functioning effectively. Patient eventually loses consciousness and enters cardiac arrest.
- Patient will eventually die
How do you treat shock?
Early recognition is key, and care for any other serious injuries so they don’t get worse and make shock worse
Maintain normal body temp - blanket if they are cold, get them to a warm space if outside and they are cold, get them out of sun/heat, etc
Rest comfortably in recovery or supine, or supine with legs elevated
- This can help
What is necessary for maintaining perfusion?
- The heart must be functioning effectively
- An adequate amount of blood must be circulating
- The blood vessels must be able to control blood flow by dilating and constricting.
What are the 3 physiological reasons that shock may occur?
- The heart is not functioning properly
- The blood vessels cannot constrict effectively
- There is not a sufficient amount of blood circulating in the body
What body mechanism spikes during compensated shock and then declines over the rest of the stages of shock?
Respiration
What body mechanism constantly climbs over the entirety of the stages of shock?
Heart rate
What are some contraindications to putting a patient in the trendellenburg position/
CV system trauma (hemorrhage), spine injury, head injury due to higher intracranial pressure, (>100mmHg systolic?)
