Shock Flashcards
Define Shock
- Shock is a clinical syndrome characterised by inadequate supply of O2 meeting its demand.
- Inadequate blood supply to the organs and tissues will result in cellular dysfunction.
Classification of Shock
- Septic shock
- Cardiogenic shock
- Hypovalaemic shock
- Anaphylactic shock
- Neurogenic shock
- Distribution shock
- Obstructive shock
What is the cause of Neurogenic, Anaphylactic and Septic shock?
- Caused by decreased in peripheral resistance
a) Neurogenic shock:
- Inadequate autonomic nerve activity to arterioles.
b) Anaphylactic shock:
- Release of vasodilators by excessive immune responses.
c) Septic shock:
- Presence of vasodilatory bacterial toxins
What is the cause of Hypovalaemic and Cardiogenic shock?
- Caused my decreased cardiac output
a) Hypovalaemic shock: Reduction of blood volume
b) Cardiogenic shock: Failure of the cardiac pump
Simple pathology of Hypovalaemic shock
- Inadequate myocardial contractility
- Sympathetic overactivity causes vasoconstriction in order to maintain the blood pressure
- BP remains normal however organs are poorly perfused due to decreased blood volume.
Simple pathology of Cardiogenic shock
- Poor myocardial contractility
- Increased venous pressure results in fluid to shift out of the vascular compartment causing oedema.
- SNS overactivity causes vasoconstriction in order to maintain BP
- BP remains high or normal however organs are poorly perfused.
Simple pathology of Distributive shock
- With adequate fluid replacement, heart compensates by increasing HR.
- Vessels dilate resulting in SVR (systemic vascular resistance)
- Capillaries continue to leak fluid; worsens hypovalaemia causes oedema (pulmonary oedema)
- Changes in BP and organ perfusion
Simple pathology of Obstructive shock
- Myocardial contracts against high after-load
- Back pressure leads of venous congestion.
- SNS over activity causes vasoconstriction in order to maintain BP
- BP remains normal however organs are poorly perfused.
Factors that induce Triad of death in shock
- Hypovalaemia
- Coagulopathy
- Hyper-perfusion metabolic acidosis
Paediactic shock
- Acute illness demands increased CO(HRxSV)
- Infants have a fixed SV; dependant on increased (CO/HR)
- Myocardial compliance decreases affecting the preload to increase SV
- loss of >25% fluid circulation volume -> signs of shock
Signs/symptoms of Paediatric Shock
- Tachycardia
- Tachypnoea (rapid breathing)
- Vasoconstriction
- Decreased consciousness
- Pallor & mottled peripheries (delayed capillary refills)
- Hypotension
Signs/symptoms of shock in Elderly
- Shock progress is rapid
- Reduced compensatory mechanisms in place
- Predisposed hypothermia
- Co- morbidities present
What are principals of shock management?
- ABC
- Oxygenation
- Fluid resuscitation
- Medications
- Symptom support
- Surgery
What are your intra-collaborative care?
- FBE: Hb, Hemocrit, WCC
- ABGs: O2, CO2, PH: 7.4
- U&E: Renal function
- F&E: glucose, Na, K, lactate lvls: metabolic acidosis.
5 Cardiac enzymes: CK, troponin, LH, CKMB
What are your airway management care?
- Ensure, clear & patent
Simple -> Advanced measures
- High flow O2 Mask
- Intubation
- Circothyrotomy