Shock

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What is Shock

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SHOCK is a syndrome characterized by1- decreased tissue perfusion2-impaired cellular metabolism

Meaning that the cells are in a state of hypoperfusion where they desperately need oxygen and nutrient for survival

Two major classification of shock

1.low blood flow

2. misdistribution of blood flow

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Types of Shock

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Low Blood Flow: Cardiogenic, Hypovolemic

Maldistribution of Blood Flow: Neurogenic, Anaphylactic and Septic

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Anaphylactic Shock

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(maldistribution of blood flow)

Systemic allergic reaction to an allergen.

Causes: multiple transfusion, severe allergic reaction

S/S: Vasodilation and histamine release, hypotension, tachycardia, wheezing, abdo pain, anxiety, angioedema, rash, urticia, warm, red skin. Sense of impending doom

TX: remove allergen, adrenaline, corticosteroids, antihistamine

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Hypovolemic Shock

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Decrease in circulating blood volume (low blood flow). Can be mild/moderate/ severe

- Caused by low blood flow; occurs when intravascular fluid volume is lost - Volume inadequate to fill vascular space- Reduction in intravascular volume results in decreased venous return to heart, decreased preload, decreased stroke volume & decreased CO → decreased tissue perfusion & impaired cellular metabolism

Causes: severe trauma with massive tissue injury, hemorrhage.

S/S:

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Absolute Hypovolemia

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- Fluid is lost through hemorrhage, GI loss (e.g. vomiting, diarrhea), fistula drainage, diabetes insipidus, hyperglycemia, diuresis

-External loss of whole blood (e.g. through hemorrhage from trauma, surgery,GI bleeding)

-Loss of other body fluids (e.g. through vomiting, diarrhea, excessive diuresis, diabetes insipidus, diabetes mellitus)

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Relative Hypovolemia

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- Fluid volume moves out of vascular space into extravascular space (e.g. interstitial or intracavitary space) i.e. “third spacing”

-Pooling of blood or fluids (e.g. from bowel obstruction)

-Fluid shifts (e.g. from burn injuries, ascites)

-Internal bleeding (e.g. from fracture of long bones, ruptured spleen, hemothorax, severe pancreatitis)

-Massive vasodilation (e.g. from sepsis)

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Septic Shock

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Type: maldistribution of blood flow - presence of sepsis (blood infection)

Example of causes: pancreatitis, infection- Patient has hypotension which CANNOT BE RESERVED with fluid resuscitation and tissue perfusion abnormalities are present.

S/S: Hypotension (which results in) Tissue perfusion abnormalities

General symptoms:

- decreased urine output

- hypotension

- confusion

- difficulty breathing

-Abnormal cardiac function (arrhthymias, tachycardia)

-Chills + decreased body temperature

-Weakness

-(Decreased platelet count, abdominal pain related to GI ↓peristalsis and risk for necrosis)

Signs & symptoms depend on stage

1. Initial

2. Compensatory

3. Progressive

4. Refractory

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Septic Shock: compensatory s/s

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Hypotension, elevated BP,GI slow persistalisis,cool clammy skin,increase depth and resp rate.

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Septic Shock: Progressive s/s

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- Edema (anasacra),(fluid leaks from vascular space – affects organ & decreasing their perfusion)

-Tachypnea, crackles in lungs, increased effort to breath,

-decrease BP (Cardiac output begins to fail), weak peripheral pulse,

-change in mental status,

-Decreased urine output-Metabolic acidosis-Myocardial dysfunction (dysrhythmias, myocardial ischemia, MI)

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Septic Shock: Refractory s/s

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-worsening hypotension-tachycardia-poor CO

– cool clammy skin, weak pulses,

-if not reversed: cerebral flow cannot be maintained and cerebral ischemia may progress to death

Recovery unlikely – organs in failure, body compensatory mechanism overwhelmed

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Cardiogenic Shock

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Pump failure due to impaired cardiac contractility

Causes: MI, Dysrythmia, cardiomyopathy, structural problems

S/s:

-Decreased CO, increased CVP, tachy, poor Peripheral perfusion, confusion and agitation, oliguria, dyspnea, cool extremities

TX: dobutamine, morphene for pain

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Neurogenic Shock

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A hemodynamic syndrome of massive Vasodilation without compensation that results from the loss of SNS vasoconstrictor tone, caused by spinal cord injury at the fifth thoracic (T5) vertebra or above.

-Vasodilation leads to pooling of blood in vessels, tissues can’t be perfused (hypoperfusion) and then impaired cellular metabolism

OR

- Drug overdose (benzo, opioids)Spinal anaesthesia can block transmission & impulse of SNSdepress vasomotor centre of medulla

S/S: hypotension, bradycardia, warm and dry skin, fraccid paralysis of bowel and bladder

TX: support spine, vasopressin, dopamine and atropine