types of shock Flashcards
what is shock
blood pressure drops
peripheral perfusion is inadequate
inadequate blood supply to organs (hypoxia)
life threatening
reversible if treated early
can quickly become irreversible
multi organ failure/ organ death
types of shock
cardiogenic
obstructive
hypovolaemic
distributive
typical symptoms of shock
cold clammy hands pale, peripheral perfusion goes down
altered mental state- agitation confusion unresponsiveness
tachypnoea
tachychardia
hypotension
what are the three types of distributive shock
neurogenic
septic
anaphylactic
what is hypovolaemic shock
sudden decrease in circulating blood volume
haemorrhage - decrease in blood volume due to blood loss such as trauma. internal bleeding, intraoperative and post operative bleeding
non haemorrhage- decrease in blood volume due to fluid loss other than blood such as burns
decreased sodium and water from gi tract, skin and kidneys
what is cardiogenic shock
failure to pump blood around the body
cardiomyopathic-problems with heart muscle myocardium
myocardial infarction with ischaemia
myocardial depression
myocarditis
infarction
arrhythmic- problems with heart rate or rhythm
atrial and ventricular tachyarrhythmias
atrial and ventricular bradyarrhythmias
mechanical- problems with heart structure
tumour
other toxic substances such as drugs
infection involving heart or body severe hypertension causing damage to the heart
what happens to the mean arterial pressure in a hypovolaemic shock
drops because total peripheral resistance drops
cardiac output remains the same
what happens to the mean arterial pressure in cardiogenic shock
mean arterial pressure drops because the cardiac output drops
the total peripheral resistance remains the same
what is obstructive shock
obstruction to cardiac outflow or filling
pulmonary embolism- large clot in pulmonary trunk or arteries
severe pulmonary hypertension
cardiac tamponade- fluid around the heart impacting filling
constrictive pericarditis- thickened or fibrotic pericardium
restrictive cardiomyopathy- stiffening of heart chambers
tension pneumothorax- can impact filling of the heart
abominal compartment syndrome
how is mean arterial pressure in obstructive shock
the cardiac output decreases decreasing the mean arterial pressure, total peripheral resistance remains the same
what is distributive shock
systemic wide vasodilation where intravascular volume is redirected to the interstitial space
three types- anaphylactic, septic, neurogenic
what is anaphylactic shock
severe allergic reaction
allergen enters blood stream and results in exaggerated inflammatory response
allergen joins to receptors causing histamine release
massive release of histamine triggers systemic vasodilation
bronchiole constriction and tongue swelling
what is septic shock
uncontrolled inflammatory response to infection
release of cytokines resulting in systemic vasodilation and capillary leakage
more common in icu and immunosupressive patients
causes infections-gram positive bacteria
gram negative bacteria
viral
fungal
parasitic
what is a neurogenic shock
severe traumatic brain or spinal cord injury compromises the sympathetic nervous system results in unopposed parasympathetic response decrease in vascular resistance, vasodilation
presents with hypotension, bradyarrythmias, temperature regulation,
occurs with spinal cord injury above level of t6
what happens to mean arterial pressure in distributive shock
cardiac output remains the same
decrease in total peripheral resistance
shock occurs when body’s tissues and organs dont recieve enough blood or oxygen
what are the 4 main types
hypovolaemic shock
distributive shock
cardiogenic shock
obstructive shock
investigations for shock
full blood count
drop in haemoglobin
a white cell count
urinalysis- white cell count
arterial and venous blood gas-
acidosis
hyperlactatemia
ecg- electrocardiogram
coagulation studies
echocardiogram
chest x ray
consider other imaging- ct abdomen pelvis
injection screens- blood cultures c reactive protein procalcitonin
what is the general management for shock
fluid resuscitation
blood transfusion
general first aid
medications to increase bp- metaraminol
emergency surgery
intravenous antibiotics- for septic
intravenous steroids- allergy medication for anaphylactic
what is shock index
heart rate/ systolic blood pressure
0.5 to 0.7 is normal range
whats the first line vasopressor for septic shock
nore epinephrine
