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21 Cards in this Set
- Front
- Back
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SHOCK
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a life-threatening condition that occurs when the body is not getting enough blood flow. This can damage multiple organs. Leading to death if untreated.
Shock is the end stage of all diseases, and symptoms will often be dependant on the underlying cause. |
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3 Stages of Shock
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Stage I (also called compensated, or nonprogressive), -
Stage II (also called decompensated or progressive), Stage III (also called irreversible). |
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COMPENSATED NONPROGRESSIVE SHOCK
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30 sec -48 hrs
A. Decrease in BP leads to an increase in the sympathetic responses 1. Skin vasoconstriction 2. Vasoconstriction to the kidneys ↓ Urine Output →Renin (Angio I, II → Vasoconstricts) (Aldosterone →Na reabsorption and H2O retention) 3. Release of Epinepherine and NE 4. Increases Heart Rate and the force of the contraction B. Release of Aldosterone to reabsorb Na+ and H2O follows Na+ C. Release of ADH to reabsorb H2O D. Hypoxia leads to an increase of blood flow to the tissue but has a harmful effect by increasing blood flow |
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DECOMPENSATED PROGRESSIVE SHOCK
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Loss of 15-20% of blood volume and the deterioration of the cardiovascular system
A. Decrease of BP below 60 mmHg leads to myocardial ischemia and a weakened heart muscle and a decreased cardiac output and a further decrease of BP setting up a positive feedback loop B. Decrease of BP below 50 mmHg leads to general vasodilatation causing further loss of BP C. Increased Hypoxia leads to the increased permeability of the capillaries due to loss of hydrostatic pressure causing the loss of blood plasma into the tissue decreasing blood volume. D. Intravascular Clotting -Decrease in blood volume leads to a ↓ in the velocity of the blood and an ↑ viscosity. This allows the platelets to aggregate in the vessel leading to clot formation, causing obstructions ( ↑ Viscosity = ↓Velocity) E. Cellular Destruction is caused by the lysomosal rupture and ↓ in the activity of the mitochondria, active transport and general metabolism. F. Build up of lactic acid lead to acidosis with pH dropping to 7.35- 6.80 or lower |
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IRREVERSIBLE SHOCK
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Heart deteriorates until it can no longer pump and death occurs.
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S/S of Shock
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All organs may be affected.
As the brain is affected, the patient may become confused or lose consciousness (coma). There may be chest pain as the heart itself doesn't get an adequate oxygen supply. Diarrhea may occur as the large intestine becomes irritated due to hypotension. Kidneys may fail and the body may stop producing urine. The skin becomes clammy and pale. ----------------------------------------- urine output less than 20 mL/hr pale, cold clammy skin rapid shallow breathes rapid thready pulse MAP of less than 60mm Hg in adults Jugular vein distention severe anxiety decreased LOC pulmonary crackles |
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Tx of Shock
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Check ABC
If there is bleeding that is obvious, attempts to control it with direct pressure will be attempted. A fingerstick blood sugar will be checked to make certain that hypoglycemia (low blood sugar) does not exist. In the emergency department, diagnosis and treatment will occur at the same time. Patients will be treated with oxygen supplementation through nasal cannulae, a face mask, or endotracheal intubation. The method and amount of oxygen will be titrated to make certain enough oxygen is available for the body to use. Again, the goal will be to pack each hemoglobin molecule with oxygen. Blood may be transfused if bleeding (hemorrhage) is the cause of the shock state. If bleeding is not the case, intravenous fluids will be given to bolster the volume of fluids within the blood vessels. Intravenous drugs can be used to try to maintain blood pressure (vasopressors). They work by stimulating the heart to beat stronger and by squeezing blood vessels to increase the flow within them. Keep patient warm. Continous V/S monitoring. Trendelenburg position (except for Hypovolemic Shock) - legs raised and head down to improve blood flow to the brain ---------------------------------------------- -Ensure patent airway -Start or KVO IV -Administer Oxygen -Obtain specimens of blood, urine, wound drainage, and sputum for culture -Increase IV fluid rate -Use aseptic technique -Handle client gently -Examine client for overt bleeding -Elevate clients feet, keeping head flat or at 30 degree angle -Take VS every 5 minutes until stable -Administer medications as prescribed ( heparin during phase 1, clotting factor platelets and plasma during phase 2) -DO NOT LEAVE CLIENT |
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Types of Shock
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Hypovolemic Shock
Hemorrhagic Shock Cardiogenic Shock Neurogenic Shock Hypoglycemic and Hyperglycemia Shock Anaphylactic Shock -------------------------------------------------------- Respiratory Shock Septic Shock Metabolic Shock Psychogenic Shock |
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Hypovolemic Shock
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Hypovolemic (hypo=low + volemic=volume) shock due to water loss can be the endpoint of many illnesses, but the common element is the lack of fluid within the body.
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Hemorrhagic Shock
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A subset of hypovolemic shock occurs when there is significant bleeding that occurs relatively quickly. Trauma is the most common example of bleeding or hemorrhage, but bleeding can occur from medical conditions
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Cardiogenic Shock
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When the heart loses its ability to pump blood to the rest of the body, blood pressure decreases. Although there may be enough red blood cells and oxygen, they can't get to the cells that need them.
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Neurogenic Shock
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In brain or spinal injury, the sympathetic trunk stops working and blood vessels dilate and result in blood pooling away from the heart. Since there isn't enough blood returning to the heart, the heart has a hard time pumping blood through the body.
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Hypoglycemic Shock
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If not enough food is ingested, then the blood sugar drops (hypoglycemia) and no glucose is available to enter the cells, even if there is enough insulin to permit glucose to enter the cells. The brain is very susceptible to low blood sugars, and coma has a very quick onset. Treatment is providing sugar. If the person is awake enough to swallow, a sugar solution by mouth is used, otherwise, intravenous fluids containing glucose are provided. If the lack of sugar was of short duration, the person will awaken almost immediately after treatment. If blood sugars remain low for prolonged periods of time, the brain's ability to recover is potentially lost.
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Hyperglycemic Shock
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When blood sugar levels spiral high out of control, there is risk of significant dehydration and shock. If there is not enough insulin in the blood stream, cells cannot use the glucose that is present, and instead turn to an alternative anaerobic metabolism to generate energy. Since glucose can't enter cells to be used, hyperglycemia (hyper= high + gly=sugar = emia) occurs as the glucose level builds up in the blood stream. The kidneys try to excrete excess sugar, but because of chemical concentration gradients between blood and urine, significant amounts of water also are lost. The body quickly becomes dehydrated and blood pressure drops, decreasing blood flow to cells. Cells which are now lacking glucose inside them are now starved of oxygen and turn to anaerobic metabolism, causing acid waste product build up. Excess acid in the body changes the metabolism for all organs, making it more difficult for oxygen to be used. Conditions will continue worsen until insulin and significant fluids are given to the patient.
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Anaphylactic Shock
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When the body develops an allergic reaction to some outside chemical or substance, it can activate its immune system to combat that substance.
excess response and multiple organ systems in the body can be affected and fail. This is known as anaphylaxis. |
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Psychogenic Shock
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cause by an overwhelming emotional factor. patient usually Faints due to inadequate bld supply to brain.
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Respiratory Shock
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trauma to the resp. system, lungs are unable to supply enough oxygen to the blood
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Septic Shock
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Caused by an overwhelming systemic infection resulting in vasodilation leading to hypotension.
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Endotoxin Shock
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is a septic shock due to release of endotoxins by gram-negative bacteria.
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Metabolic Shock
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body's homoestasis is impaired (acid-base balance).
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Insulin Shock
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insulin shock a hypoglycemic reaction to overdosage of insulin, a skipped meal, or strenuous exercise in an insulin-dependent diabetic, with tremor, dizziness, cool moist skin, hunger, and tachycardia, sometimes progressing to coma and convulsions.
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