Shocked Patient

Question 1

What is shock?

Answer 1

An acute circulatory failure resulting in inadequate tissue perfusion (no oxygen to tissues) and energy production (no nutrients to cells).

Question 2

What is normal tissue perfusion?

Answer 2

Relies on:
Cardiac output
Circulating volume
Peripheral vascular resistance

Question 3

What is compensatory shock? (Stage 1)

Answer 3

Mechanisms that attempt to reduce the effects of shock.

Baroreceptors detect reduced cardiac output, stimulating adrenaline and noradrenaline release - causing increased heart rate and contractility

Hypoxia of tissues results in metabolic acidosis. Ventilation increases to address acid – base balance.

Hypoperfusion of kidney activating the RAA system. Aldosterone acts on the collecting ducts to retain Na and H2O. Also causes peripheral vasoconstriction.

Question 4

What is decompensatory shock? (Stage 2)

Answer 4

Where shock is not treated, compensatory mechanism start to fail.

Fluid and proteins leak from circulation into the tissues due to peripheral vasodilation. Viscosity of blood increases.

Acidosis increases.

As gut becomes ischemic (reduced perfusion), bacteria enters the blood stream – toxic.

Increasingly stuporous or comatose.

Question 5

What is irreversible shock? (Stage 3)

Answer 5

Too much cell death that cannot be reversed.

This can lead to:
Systemic Inflammatory Response Syndrome (SIRS):
Inflammatory Injury to one organ system that can cause damage to others. Can have infectious or non-infectious causes.

Disseminated Intravascular Coagulation (DIC):
Activation of haemostatic mechanisms inducing a prothrombotic state leading to bleeding tendencies.

Multi-Organ Dysfunction (MOD):
SIRS & Septic Shock can lead to MODS. Every organ and system within the body can be affected.

Death.

Question 5

What are the 4 main types of shock?

Answer 5

Hypovolaemic
Septic/ Distributive
Cardiogenic
Obstructive

Question 6

What are the clinical signs of shock?

Answer 6

Tachycardia
Hypotension
Tachypnoea
Pale mms
Prolonged CRT
Hypothermia + cold extremities
Weakness/depression
Reduced urine output

Question 7

How would you examine a patient with shock?

Answer 7

• History
• Physical examination
• MM colour, CRT, hydration
• Heart rate
• Blood pressure
• Pulse rate and quality – peripheral pulse
• Temperature – core and periphery
• Blood tests – Hb, PCV/ TS, Total protein, glucose, BUN, lactate measurement

Question 8

How would you manage a patient with shock?

Answer 8

Identify and rectify cause.

Establish adequate ventilation and oxygenation.

Restore optimum intravascular volume.

Maintain adequate cardiac output and renal perfusion.

Maintain optimum internal metabolic environment.

Question 9

What is the treatment for shock?

Answer 9

• Oxygenate; resuscitation where required
• Provide analgesia
• Control haemorrhage
• IVFT, increase circulating volume + restore perfusion
• Bicarbonate to address metabolic acidosis/ Hartmanns
• (Antibiotics)
• Maintain body temperature

Question 10

What is the nursing care for a patient with shock?

Answer 10

• Carry out first aid
• Select method of oxygen delivery
• Organise fluid administration
• Analgesia – under the direction of the veterinary surgeon
• Dressings – haemorrhage control
• Warming patient
• Stress reduction measures
• Constant monitoring vital signs and records
• Liaise with owners

Question 11

What is hypovolaemic shock?

Answer 11

A lack of fluid in the intravascular compartment.