Shock

Stages of Shock

Decompensated

Irreversible

Compensated

Shock: Is the state of collapse and failure of the cardiovascular system that leads to hypo-perfusion. The failure in the "pump" is caused by inadequate preload, inadequate contractile strength, inadequate heart rate, and/or excessive after-load. The failure with the fluid is caused by hypovolemia. The failure in the container is caused by a dilated container without change in fluid volume or a leak in the container.

Hypo-perfusion: Is inadequate perfusion of body tissues, resulting in the inadequate supply of oxygen and nutrients to body tissues. This inadequate supply of oxygen results in the cells metabolism changing from aerobic to anaerobic.

The body needs a functioning Pump(heart), adequate fluid(blood), and intact blood vessel system(including constriction and dilation).

Central Shock

Effects

Effects

Indicators

Obstructive Shock

Peripheral Shock

Cardiogenic Shock

Distributive Shock (Three Types)

Hypovolemic Shock

Exogenous

Septic Shock

Causes

Ischemic Heart Disease

Presentation

External and Internal Haemorrhage

Decompensated CHF

40% myocardial death(approx.)

Endogenous

Cardiogenic shock occurs when the heart is unable to circulate sufficient blood to maintain peripheral oxygen delivery. Not caused from trauma (decreased pump performance)

Causes

Most often left ventricle

Presentation

Decreased Blood Pressure

Variable Heart Rate

Pale, cool, moist skin

Crackles in lungs

Obstructive Shock occurs when blood flow to heart or great vessels is blocked or restricted. Unlike cardiogenic shock, obstructive shock can be caused from trauma.
(decreased pump performance due to obstruction)

SOB(Pulmonary Edema)

Jugular Vein Distention

Altered Mental Status

ECG Changes

Cardiac Tamponade (Muffled lung sounds)

Constrictive Pericarditis

Aortic Stenosis

Tension Pneumothorax (Absent lung sounds)

Pulmonary Embolism

Increased Heart Rate

Decreased Blood Pressure

Increased Respiration Rate

Chest Pain

Shortness of Breath

Jugular Vein Distention

Altered Mental Status

ECG changes

Hypovolemic Shock occurs when circulating blood volume is
not sufficient to perform adequate perfusion. Early recognition and transport is key with patient showing signs of hypovolemic shock
( Low Fluid Volume)

Long bone or Pelvic Fracture

Blunt or Penetrating Injury

Amputation

Multisystem Injury

Fluid loss contained inside the body

Crush Injury

Dehydration

Anaphylaxis

Presentation

Severe Burns

GI Losses

Fever, hyperventilation

Increased Sweating

Internal Losses

Pancreatitis

Peritonitis

Ileus

Plasma Loss

Apparent MOI

High blood or fluid loss

Increased Heart Rate

Decreased Blood Pressure

Altered Mental Status

ECG Change

Lack of JVD

Distributive Shock causes widespread dilation of resistance vessels(small artioles), the capacitance vessels (small venules), or both. This causes blood to pool, blood pressure to drop, and tissue perfusion to decrease. Three problems occur with septic shock 1) Insufficient volume in container. 2) Fluid that leaks out often collects in the respiratory system. 3) Larger than normal capillary beds have to contain smaller than normal intravascular fluid. Sepsis + systolic BP less than 90mm Hg = Septic shock

Neurogenic Shock

Anaphylactic Shock

Result of widespread infection

Activation of Inflammatory-Immune Response

Increased microvascular permeability

Vasodilation

Third space fluid shift

Microthrombi

Presentation

Crackles in lungs if pulmonary edema

Flushed or pale, hot or cold, moist skin

Increased Heart Rate

Decreased Blood Pressure

Neurogenic Shock usually results from a spinal cord injury above the T6 Vertebrae. This causes loss of normal sympathetic tone and vasodilation. The Tunica Media is effectively cut off from the sympathetic nervous system which results in hypo-perfusion. Neurogenic shock also inhibits the the release of catecholamines to the heart which causes bradycardia.

Causes

Presentation

Spinal cord injury about vertebrae T6

Brain injury

Decreased blood pressure(maybe be immediate)

Bradycardia

Pink, dry, warm skin

Respiratory arrest(if high spinal injury)

Priaprism

Absence of sweating below injury

Presentation

Causes

Anaphylaxis is caused by sensitization to a foreign substance. It results in widespread vascular dilation resulting in relative hypovolemia. Histamine and other vasodilator proteins are released which causes severe bronchoconstriction, urticaria, and swelling caused by interstitial fluid.

Allergic reaction

Decreased Blood Pressure

Increased heart rate

Shortness of Breath

Angioedema

Wheezes or stridor( no sounds)

Flushed, warm, moist skin

Effects

RAAS activated

Increase in Respiratory Rate

Maintained(or increased) Blood Pressure

Increase in Respiratory depth

Helps maintain acid-bas balance by respiratory alkalosis

Indicators

Agitation, anxiety, restlessness

Sense of impending doom

Weak, rapid pulse

Cool, moist skin

Palor with cyanotic lips

SOB

Nausea, vomiting

Delayed cap -refil in infants and children

Thirst

Increased Heart rate by simulation of sympathetic nervous system

Increased PVR( Sympathetic stimulation and RAAS)

Decreased urine output

AMS

Hypotension

Difficulty Breathing

Thready or absent peripheral pulses

Impending cardiac arrest

Ashen, mottled, or cyanotic skin

Diminished urine output

Dilated pupils

Compensatory mechanisms fail

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Decreased Temperature

Increased Respiratory Rate

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Increased Heart Rate

Results in

Decreased LOC

Decreased BP

Blood shunted to brain, heart, kidneys from extremities

Decreased HR

Decreased RR

End Organ Failure

All blood being shunted to brain, heart

I found this assignment to be very helpful. I typically find Nancy's to be a mouthful and this map was a very effective means to organize my thoughts in a visual way(I like to learn visually). Coggle also allowed my thoughts to be neat and concise. When making this mind map I really wanted my thoughts to be clear and "listed". I only added extra paragraphs for brief descriptions fo each type of shock. I added a RAAS flow chart I found online as well, as I found this one to be the easiest for me to understand.

RAAS

This is a RAAS flow chart I found online. It was the one I liked the most and most systematic

Treatment

Sympathomimetic

Low Dose Dopamine

Indicated for Cardiogenic Shock

Low dose produces dopaminergic efficts(0.5-5ug/kg/min)

Treatment

Treat the cause

Needle Decompression

Dual Large Bore IV

Non Rebreather at 15Lpm

Dual Large Bore IV

Non- Rebreather at 15Lpm

Treatment

IV Fluids

Cystolloid Solution

250ml Bolus

Treatment

Sympathomimetic

High Dose Dopamine

Indicated for Septic shock after fluid bolus of at least 2L of NS

5-10ug/kg/min produces B1 effects

10ug/kg/min produces alpha effects

Dual Large Bore IV

Non Rebreather at 15Lpm

Vassopressor/inotrope

Increase heart force of contraction

Norepinephrine

Increase Stroke Volume Resistance

Treatment

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Sympathomimetic

High Dose Dopamine

Indicated for Septic shock after fluid bolus of at least 2L of NS

5-10ug/kg/min produces B1 effects

10ug/kg/min produces alpha effects

Dual Large Bore IV

Non Rebreather at 15Lpm

Vasopressor/inotropic

Inotropic Agent

Norepinephrine

Increase Stroke Volume resistance

Increase Contraction force of heart

Treatment

Epinephrine

Indicated for Severe allergic reaction

0.3-0.5mg of 1:1000 for Anaphylaxis

Produces A1, B1, B2, effects

Inhibits Histamine release

Chronotropic, dromotropic, inotropic effects

Diphenhydramine

Indicated for allergic reaction

25-50mg

Antihistamine with anticholinergic and sedative side effects

Salbutamol

Indicated for bronchospasm

B2 Stimulation, slight B1 stimulation

100ug/ per puff via MDI (4-6 puffs)

Ipratropium Bromide

Inhibits stimulation for parasympathetic nervous system

Indicated for bronchospasm

Inhibits Vagal stimulation(allows sympathetic nervous system to dominate

Dual Large Bore IV

Non Rebreather at 15Lpm