SHOCK

Question 1

What is the golden hour?

Answer 1

It is the initial stage is shock. Characterized by base line Mean Arterial Pressure (MAP) is deceased by 10 mm Hg.
Compensatory function is in full effect, and this makes detection difficult. The mechanisms are: mild vasoconstriction and Increased HR. A slight increase in systolic BP may be seen.

Question 2

Compensatory stage of shock

Answer 2

This is the second stage is shock. The blood pressure is reduced leading to reduced profusion to the kidneys. The kidneys respond with a release of renin, Aldosterone, ADH, epi, and NE which are attempts to both retain fluid and increase bp. This reduced profusion to the kidneys puts non vital organ and the kidneys at ischemia risk, which also reduces urine output. The reduced bp and oxygenation starts to create an increase in Co2 which then creates acidosis and hyperkalemia. 
Subjective info: thirst and anxiety
Objective info: tachycardia
	increases RR
	cool extremities	
	decreased 02 sat
	decreased urine output

Question 3

What is the progressive stage in stock?

Answer 3

This stage is an emergency. A person can live if taken out of this stage within 1 hour.
The MAP is reduce 20 or more and the Compensatory mechanisms are working full bore but not sufficient. Because of the reduced oxygen profusion vital organs are hypoxic and non vital are ischemic. There is an increased level of toxic metabolites which cause even more cell damage. The blood become even more acidic and there is even more potassium within the blood.

Subjective info: Greater thirst
	deeper anxiety
	impending doom
	confused
Objective: rapid weak pulse
	further reduced BP
	pallor and cyanosis
	zero urine output
	5-20% reduction of O2 saturation

Question 4

What is the refractory stage of shock?

Answer 4

This is the irreversible stage of shock. There is nothing the medical staff can do that will proliferate the tissues with enough oxygen, there has been to much damage to the tissues. There are too many toxic metabolites. 
Clinical manifestations:
	Loss of consciousness
	Non-palpable pulse
	cold, dusky extremities
	slow shallow respirations
	unmeasurable  O2

Question 5

MODS (multiple Organ Dysfunction Syndrome)

Answer 5

This is a viscous cycle where metabolites cause cell damage and block capillary beds with micro-thrombi. This leads to cell death by the blocking of capillaries, that which kills more cells. The death of these cells releases more toxic metabolites. These micro-thrombi will block the kidney, liver, heart and brain first.

Question 6

Hypovolemic shock

Answer 6

This is the type shock that results from a loss of fluid, this can result from: a loss of fluid, dehydration. The fluid deficit causes a reduced volume to push around the body, this decreases BP. The body tries to compensate by vasoconstriction

Question 7

Cardiogenic shock

Answer 7

This type of shock results from direct pump failure of the heart. The fluid volume is not affected. Ex. MI, cardiac arrest. The lack of circulation leads to hypoxia in the tissues, leading to shock.

Question 8

Obstructive shock

Answer 8

This is pressure being put upon the heart, thus making it not able to pump effectively. Arterial stenosis (stiffness of valves of the heart, cardiac tamponade (which is fluid being built up in the area between the myocardium and the pericardium), pulmonary embolism( the pressure within the blocked blood vessel is too great for the heart to overcome and thus the heart can not pump effectively), Tension pneumothroax, pulmonary hypertension.

Question 9

Distributive shock

Answer 9

This can be either Chemical or Neurogenic origin

Chemical: This is caused by a chemical that causes vasodilation or wide spread inflammation. This is Anaphylaxis and septic shock,capillary leaks from burns, liver disease.

Neurogenic: This causes widespread vasodilation due to loss of sympathetic tone. Ex. Spinal nerve damage, head injuries, anesthesia, pain or stress.