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SHOCK depositphotos_51408813-stock-photo-electric-shock, Caused when…
SHOCK
Stages
Compensated
Decreased Perfusion
Normal Mental Status
Tachycardia
Defense mechanisms are successful in maintaining perfusion
Presentation
Uncompensated
Hypotension
Delayed cap refill
Increased Heart Rate
Thready Pulse
Confused
Defense mechanisms begin to fail!
Presentation
Irreversible
Apnea
Profound Hypotension
Bradycardia
No Pulse
Unresponsive
Presentation
Defense mechanisms have completely failed, death
What Is It
All types of shock are a result of inadequate
tissue perfusion
Efficient perfusion to body tissue requires three working mechanisms
Pump (Heart)
Causes of inadequate perfusion relating to the Pump
Inadequate preload
Poor contractibility
Excessive afterload
Inadequate heart rate
A healthy Pump
requires a strong and stable organ that can effectively push blood to the lungs and the rest of the body.
Fluid (Blood)
Causes of inadequate perfusion relating to the Fluid
Hypovolemia
Healthy fluid
requires adequate amounts of hemoglobin to carry oxygen to the tissues, an adequate volume of the fluid itself (blood), and an adequate blood pressure to reach the body's tissues.
To maintain adequate blood pressure and blood volume, the body uses the Renin-Angiotensin-Aldosterone System
This system uses the kidneys to detect when plasma volume is low. The kidneys then releases renin, which converts angiotensinogen to angiotensin I, which then converts to angiotensin II.
Angiotensin II then causes
Vasoconstriction
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Thirst
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The release of ADH
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The release of aldosterone by the adrenal cortex
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Container (Vessels)
Causes of inadequate perfusion relating to the Container
Excessive dilation
Inadequate systemic vascular resistance
A healthy Container
requires a closed and pressurized system that can efficiently transport blood to the tissues of the body.
Shock is a type of
anaerobic metabolism
Anaerobic metabolism results in
Inadequate energy production
Metabolic failure
Lactic acid production
Metabolic acidosis
CELL DEATH
Anaerobic metabolism is caused by
inadequate cellular oxygenation
Types
:red_flag:
Distributive
:red_flag:
Anaphylactic
:no_entry:
Treatment
Bronchodilators
Epinephrine
Antihistamines
SIgns
Hives
Wheezing
Hypovolemia
Hypotension
Rapid Pulse
Caused by a massive systemic allergic reaction, resulting in a large release of histamine and increased membrane permeability and dilation of the vessels.
Anaphylactic Shock Video
:explode:
Septic
:explode:
Treatment
Administer fluid
Respiratory support
Administer vasopressors
Signs
Widespread infection
Hypotension
Cool, pale extremites
Tachycardia
Caused by systemic infection
Septic Shock Video
Neurogenic
:red_cross: :red_cross:
Signs
Spinal cord injury
Loss of response of sympathetic nervous system
Decreased perfusion to organs
Decreased perfusion to tissue
Pooling of blood
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Treatment
Administer vasopressers
Immobilize to prevent further damage
Caused by a decrease in sympathetic tone or an increase in parasympathetic tone, which results in a decrease in vascular tone. This causes massive vasodilation, which decreases SVR and preload, then decreasing cardiac output, and finally,
decreasing tissue perfusion.
Neurogenic Shock Video
Has five main sub-types, all of which result in a leaky container
Toxins
Endocrine
:warning:
Obstructive
:warning:
Examples
Cardiac temponade
Tension Pneumothorax
Pulmonary embolism
Treatment
Pericardiectomy
Needle decompression
Administer thrombolytics
Caused by a mechanical obstruction of the blood vessels (container) or the heart (pump). Blood flow is blocked or reduced.
Obstructive shock can lead to cardiogenic shock if left untreated!
Obstructive Shock Video
:black_flag:
Hypovolemic
:black_flag:
Two Types
Exogenous
External bleeding
Blunt or penetrating injuries to vessels or organs, long bone or pelvic fractures, major vascular injuries, and multisystem injuries.
Endogenous
Dehydration, burn injury, crush injury, anaphylaxis.
When fluid loss is contained in the body
Treatment
Maximize oxygen delivery
Control further blood loss
Fluid resucitation
Signs
Increased anxiety
Cool, clammy skin
Confusion
Weakness
Pale skin color
Rapid breathing
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Hypovolemic Shock Video
:forbidden:
Cardiogenic
:forbidden:
Caused when the heart is unable to pump a sufficient amount of blood to maintain adequate oxygen delivery.
Signs
Rapid breathing
SOB
Tachycardia
Unresponsiveness
Weak pulse
Hypotension
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Treatment
Oxygen delivery
CPAP
Dopamine
Nitroglycerin
Cardiogenic Shock Video
Caused when blood volume is not high enough to maintain adequate perfusion
