Shock Flashcards
Shock definition?
- Circulatory system abnormality resulting in:
- inadequate tissue perfusion
- decreased cellular metabolism
Classification of Shock
Cardiogenic
Hypovolemic
Distributive
Obstructive
Types of Distributive Shock?
Neurogenic
Anaphylactic
Septic
Cardiogenic Shock process?
Heart with decreased ability to pump blood
↓
↓ stroke volume
↓
↓ Cardiac Output
↓
↓ tissue perfusion and cellular metabolism
CV manifestations Cardiogenic Shock?
- Early: Tachycardia, Hypotension, Narrowed pulse pressure
- ↓ perfusion-peripheral, renal
manifestations of Cardiogenic Shock?
1) Resp
2) Integument
3) Neurological
1) pulmonary congestion
2) cool, clammy skin
3 confusion
Hypovolemic Shock process?
Loss of intravascular fluid volume
↓
↓ preload
↓
↓ stroke volume
↓
↓Cardiac Output
↓
↓ tissue perfusion and cellular metabolismWhat are 2 types of hypovolemia?
Absolute and Relative
Absolute hypovolemia?
due to fluid loss
Relative hypovolemia?
due to fluid shift
Results when fluid volume moves out of the vascular space into extravascular space (e.g., interstitial or intracavitary space)
Relative hypovolemia
Causes of Absolute hypovolemia?
- Hemorrhage
- GI loss (e.g., vomiting, diarrhea)
- Fistula drainage
- Diabetes insipidus
- Hyperglycemia (water follows glucose)
- Diuresis
Clinical manifestations of Hypovolemic Shock?
- ↓ stroke volume, CVP
- ↓urine output
- ↑ RR and depth
- anxiousness
When does the SNS mediated response occur in hypovolemic shock?
- when the fluid loss is > 15% of TBV (750mL)
- causes ↑ HR, RR and depth
Neurogenic Shock process?
Massive vasodilation = ↓ preload = ↓ stroke volume = ↓CO = ↓ tissue perfusion and cellular metabolism
Causes of Neurogenic Shock?
- spinal cord injury (T5 or higher)
- spinal anesthesia
- Vasomotor center depression (drugs)
Poikilothermia
Temperature dysregulation where the body assumes the same temp as the environment
S/S of Neurogenic Shock?
Hypotension, bradycardia, poikilothermia
Anaphylactic Shock physiology?
- massive vasodilation
- release of vasoactive mediators
- increased capillary permeability
Symptoms of Anaphylactic Shock appear within what timeframe?
< 20 mins
Systemic inflammatory response to infection
Sepsis
S/S of Septic shock ?
- ↓bp despite fluids
- resp failure
- vasodilation
- myocardial depression
- Hypo or Hyperthermia
- ↑ Coagulation and inflammation
- ↓ Fibrinolysis
Generalized inflammation in organs remote from the initial insult?
Systemic Inflammatory Response Syndrome (SIRS)
Multiple Organ Dysfunction Syndrome (MODS)
- failure of > 2 organ systems
- homeostasis cannot be maintained without intervention
- results from SIRS
