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12 Cards in this Set
- Front
- Back
What is Shock |
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 |
Low Blood Flow: Cardiogenic, Hypovolemic Maldistribution of Blood Flow: Neurogenic, Anaphylactic and Septic |
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Anaphylactic Shock |
(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 |
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 |
- 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 |
- 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 |
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 |
Hypotension, elevated BP,GI slow persistalisis,cool clammy skin,increase depth and resp rate. |
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Septic Shock: Progressive s/s |
- 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 |
-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 |
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 |
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 |