Shock Flashcards
Cardiogenic shock
Systolic or diastolic dysfunction and the pumping action of the heart results in reduced cardiac output
What is shock?
A syndrome characterized by decreased tissue perfusion and impaired cellular metabolism.
Imbalance between the supply of and demand for oxygen and nutrients
Causes of cardiogenic shock?
Systolic dysfunction
Inability of the heart to pump blood forward
Examples: MI, cardiomyopathy, blunt cardiac injury, severe systemic or pulmonary hypertension, myocardial depression from metabolic problems.
Causes of cardiogenic shock?
Diastolic dysfunction
Inability of the heart to feel during Diastole.
Examples: pericardial temponade, ventricular hypertrophy, and cardiomyopathy
Causes of cardiogenic shock?
Dysrhythmias
Examples:
Bradydysrhythmias
Tachydysrythmias
Causes of cardiogenic shock?
Structural factors
Structural factors:
Examples: valvular stenosis or regurgitation, Ventricular septal rupture, and tension pneumothorax
Early clinical presentation of a patient with cardiogenic shock
Tachycardia, hypertension, narrow pulse pressure.
Assessment : tachypneic, crackles, cyanosis, pallor, diaphoresis, weak pulses, cool and clammy skin, delayed cap refill, sodium and water intention, decreased urine output, anxiety confusion and agitation.
Labs: cardiac enzymes, troponin levels, BNP, ECG, chest x-ray, echo cardiogram
Hypovolemic shock
Absolute hypovolemia
relative hypovolemia- “3rd spacing”
Loss of intravascular fluid volume.
Volume is inadequate to fill the vascular space
Causes of Absolute hypovolemia?
External loss of blood examples: hemorrhage trauma surgery G.I. bleed
Loss of other body fluids:
Vomiting, diarrhea, excessive diuresis, diabetes insipidus, diabetes mellitus
Causes of relative hypovolemia?
Pulling of blood or fluid
Example: Bowel obstruction
Fluid shifts
Examples: burn injuries, ascites
Internal bleeding return
Examples: fracture of long bone, ruptured spleen, hemothorax, severe pancreatitis
Massive basal dilation
Example: sepsis
Clinical presentation of hypovolemic shock?
Increasing heart rate, CO, respiratory rate and depth, anxious, decreased urine output
Decreased cap refill, tachypnea, pallor cool and clammy skin, absent bowel sounds
Neurogenic shock
Hemodynamic phenomenon that can occur within 30 minutes of his final cord injury at the fifth thoracic vertebrae or above and last up to six weeks
Causes of neurogenic shock?
Spinal cord injury/ disease at T5 or above
Spinal anesthesia
Vasomotor center depression
Examples: severe pain, drugs, hypoglycemia, injury
Clinical presentation of neurogenic shock
hypo tension, increase or decrease temperature, bradycardia, bladder dysfunction, decreased skin perfusion, cool or warm skin, flaccid paralysis, loss of reflex activity, bowel dysfunction
Anaphylactic shock?
Acute or life threatening hypersensitivity (allergic) reaction to a sensitizing substance
