Shock Flashcards
What is shock?
Decreased tissue perfusion and impaired cellular metabolism
Imbalance in supply/demand for O2 and nutrients
What are the two categories shock?
Low blood flow
Maldistribution
What are examples of “low blood flow” (LBF) shock?
- Hypovolemic
- Cardiogenic
- Dysfunction in cardiac output
What are examples of “maldistribution” shock?
- Septic shock
- Anaphylactic shock
- Neurogenic shock
- ** Same amount of blood in the vessel, but the vessel is extremely dilated
What are early manifestations of LBF shocks?
Tachycardia Tachypnea Hypotension Narrowed pulse pressure Increased myocardial O2 consumption - Heart is working harder to fuel itself and the brain
Treatment for LBF shock
Priority - Restore blow flow to the myocardium
Thrombolytic therapy Angioplasty with stenting Emergency revascularization Valve replacement *** Treat underlying problem
Hypovolemic shock is known and the….
“Classic” shock
- Most commonly seen
S/S of Hypovolemic shock
Anxiety Tachypnea Increase in CO Increased HR Decrease in stroke volume, PAWP, and urinary output
If loss is greater than ______% blood volume needs to be replaced
30%
- Pt needs to be replaced with blood products, NOT fluids. Fluids do NOT have the ability to transport O2 to the tissues and that is what the body needs
Priorities in treating hypovolemic shock
Stop fluid loss and restore circulating volume
Fluid replacement
Vasopressors
Neurogenic shock happens within _____ minutes of a spinal cord injury at the T6 or aboved
30 minutes
What are the results of neurogenic shock?
Massive vasodilation, leading to the pooling of blood in vessels
S/S of Neurogenic shock
Hypotension Bradycardia Temp dysregulation - Resulting in heat loss Dry skin Poikilothermia - Taking on the temp of the environment
Treatment for Neurogenic shock
Stabilize spinal cord Treat hypotension with vasopressors Treat bradycardia with atropine Use fluids cautiously, as hypotension is generally not related to fluid loss Monitor for hypothermia
Anaphylactic shock is an _______, life-threatening, ___________ reaction
Anaphylactic shock is an ACUTE, life-threatening, HYPERSENSITIVITY reaction.
What happens in anaphylactic shock?
Massive vasodilation
Release of mediators (they cause inflammation)
Increase in capillary permeability
S/S of anaphylactic shock
Anxiety, confusion, dizziness Sense of impending doom Chest pain Incontinence Swelling of lips, tongue, and angioedema Wheezing, stridor Flushing, pruritus, urticaria Respiratory distress and circulatory failure
Treatment of anaphylactic shock
Epi and/or Benadryl
Maintaining patient’s airway
Aggressive fluid replacement
IV corticosteroids
What is septic shock?
Presence of sepsis (infection) with hypotension despite fluid resuscitation and tissue perfusion abnormalities
What happens to the blood in septic shock?
Increased coagulation and inflammation
Decreased fibrinolysis
- Causing the formation of microclots
Basically DIC
S/S of septic shock
Tachypnea/Hyperventilation Temp dysregulation Decreased urine output Altered LOC GI dysfunction Respiratory failure is common
Treatment of septic shock
IV corticosteroids
Antibiotics after cultures are obtained
What is obstructive shock?
When a physical obstruction to blood flow occurs with decreased cardiac output