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.
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