Shock Flashcards
What are the 5 main types of shock?
Septic Shock - Infectious Process
Hemorrhagic Shock - Blood Loss or hypovolemia
Neurogenic Shock - Neurologic/Spinal Injury (due to spinal trauma)
Cardiogenic Shock - Cardiac Dysfunction (pumps don’t work- volume is fine)
Anaphylactic Shock - Allergic Reaction (immune response)
What is the hallmark of shock?
hypotension- blood pressure is low, organs are under perfused and that is what kills them
What are some immediate intervention for shock patients?
1) check Airway, breathing, circulation (ABCs) every few minutes
2) DO NOT elevate head
3) Check for evidence of head, neck or spine injury and if known place in appropriate shock position. If spinal injury is suspected then “log roll” patient keeping head, neck and spine in line and rolling as a unit
4) If nauseated or vomiting, and spinal injury is not suspected, turn head to the side to prevent aspiration.
What is the shock position?
laying on back with feet elevated, keep person warm and comfortable, and turn the victim’s head to one side if neck injury is not suspected
Why do you want to elevate the feet?
to increase blood flow to the brain
What things would you expect physiologically in septic shock?
vasodilation with decreased systemic vascular resistance, peripheral edema, and tachycardia and hypotension secondary to decreased intravascular volume
What clinical signs would you see in septic shock?
fever (usually over 38.5C), chills, dyspnea, rapid heart hate, respiratory acidosis, confusion, rashes possible
treat the fever first
What is the basis of hemorrhagic shock?
Hemorrhagic, or hypovolemic shock is caused by the loss of more than 20% of your body’s blood or fluid supply
Cardiac function is insufficient to maintain adequate blood flow, and therefore oxygen, to vitals organs
cause is blood loss
What are the causes of hypovolemic shock?
excessive or prolonged diarrhea
severe burns
protracted and excessive vomiting
excessive sweating
What are some signs of internal hemorrhage?
Abdominal Pain
Bright Red Blood in Stool – BRBPR (common from colon)
Black Tarry Stool – Melena (from higher in GI than colon)
Hematuria
Vaginal Bleeding
Hematemesis
Abdominal Distension
What is the primary treatment of hypovolemic shock?
Intravenous Volume
IV Fluids
Blood products if hemorrhage is the etiology
What is the secondary treatment of hypovolemic shock?
1) Ionotropes (make the heart pump harder)
a) Dopamine – beta 1 and alpha receptors depending on dose
b) Dobutamine – beta 1 and beat 2 receptors
2) Vasoconstrictors- epi/norepinephrine (can cause other organ failure- especially renal damage)
What is the main cause of neurogenic shock?
spinal cord injury
How is neurogenic shock different from spinal shock?
spinal shock- no temporary loss of spinal reflex activity below a total or near total spinal cord injury
spinal shock= function shock, but not cardiovascular involvement
What is the appropriate treatment of neurogenic shock?
volume resuscitation, vasopressors (norepi/epi), vasopressin (antiduretic hormone) to keep volume in, Inotropes,
and then address spinal cord injury
