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Shock (Types of Shock (Distributive (differentiate from hypovolemia…
Shock
Stages of Shock
Compensated
defence mechanisms are successful in maintaining perfusion
Persentation
tachycardia
decrease in perfusion
altered mental status
Uncompensated
defense mechanisms begin to fail
Presentation
hypotension
prolonged cap refill
marked increase in heart rate
rapid thread pulse
agitation
restlessness
confusion
Irreversible
complete failure of compensatory mechanisms
death even in presence of resuscitation
Types of Shock
Hypovolemic
defined
fluid failure
decreased intravascular volume
treatment
treatment is complete when circulatory deficit and its causes have been corrected
crystalloid solution replacement for dehydration
volume replacement for hemorrhage
definitive surgery
critical are support
postoperative rehabilitation
Cardiogenic
defined
failure of the heart to pump effectively due to muscle dysfunction
treatment
improve pumping action of the heart and manage dysrhythmias
fluid replacement
drug therapy if needed
cardiogenic shock due to myocardial ischemia or infraction require
reperfusion strategies
possible circulatory support
manage tension pneumothorax and cardiac tamponade
differentiate from hypovolemia
chief complaint
chest pain
dyspnea
tachycardia
heart rate
signs of congestive heart failure
Obstructive
defined
when there is a mechanical obstruction of either the heart or vasculature
impedes the flow of blood ad products
can lead to cardiogenic shock if left untreated
examples
tension pneumothorax
cardiac tamponaede
pulmonary embolus
pericarditis
treatment
support ABC's
needle thoracostomy
chest tube
pericardiocentesis
thrombolytics / heparin
remove the obstruction
differentiate from hypovolemia
cardiac tamponade
tension pneumothorax
pulmonary embolism
Distributive
neurogenic
defined
occurs because of failure to vasoconstrict
sympathetic nervous system would normally control vasoconstriction
treatment
similar to hypovolemia
avoid circulatory overload
monitor lung sounds for pulmonary congestion
vasopressore may be indicated
annaphylactic
defined
vasculature failure
massive and systemic allergic reaction
large release of histamine
increases membrane permiability and vasodilation
treatment
subcutaneous epinepherine in acute anaphylaxis reaction
other therapies
oral
IV
IM
bronchodilators
steroids reduce inflammatory response
crystalloid volume replacement
airway management
septic
defined
vasculature failure
systemic infection
treatmet
management of hypovolemia (if present)
correction of metabolic acid-base imbalance
pre-hospital care
fluid resuscitation
respiratory support
vasopressors to improve cardiac output
thorough history to find source of sepsis
differentiate from hypovolemia
mechanism suggesting vasodilation
spinal cord injury
drug overdose
sepsis
anaphylaxis
warm flushed skin
lack of tachycardia response (not reliable)
definition
inadequate tissue perfusion along with anaerobic
metabolism