NEUROGEN

IC SHOCK
By: ERVIN VICENTE

SHOCK

Defined as a state of inadequate

perfusion, occurs when there is
inadequate circulation
Tissues are deprived of oxygen
Results in cellular metabolism
disturbance, waste accumulation
dysfunction

STAGES of SHOCK
stage ( Initial Phase)
- the cardiac output insufficient
to
meet the metabolic needs
of the body but now low enough
to
produce symptoms

1st

STAGES of SHOCK
stage ( Compensatory
Phase)
- due to catecholamine being
released
- an increase in HR. increase in
CO. Vasoconstriction

2nd

STAGES of SHOCK
stage (Progressive Stage)
- unfavorable signs and symptoms
become more apparent:

3rd

decrease blood pressure

increased heart rate
oliguria
system dysfunction begins

STAGES of SHOCK
stage (Irreversible Stage)
- myocardial depression
- massive capillary dilation
- blood remains pooled in the
extremities
- death may occur

4th

PATHOPHYSIOLOGY
INITIAL INSULT
LEADING TO
SHOCK

DECREASE TISSSUE
PERFUSION, DECREASE
OXYGENATION

ACTIAVATION OF HEMOSTATIC
RESPONCE

INCREASE SYMPATHETIC RESPONSE,

INCREASE SYMPATHETIC RESPONSE,

INCREASE RENIN-ANGIOTENSIN ACTIVAQTION

INCREASE RENIN-ANGIOTENSIN ACTIVAQTION

DECREASE RR TO INCREASE SATURATION

DECREASE RR TO INCREASE SATURATION
AND DELIVERY
AND DELIVERY

INCREASE CATECHOLAMINES AND CORTISOL

INCREASE CATECHOLAMINES AND CORTISOL

RESTORATION OF TISSUE
PERFUSSION AND OXYGENATION

compensatory progressive

irreversible

Blood pressure

normal

Sys: <80 90 mmHg Requires mechanical

and pharmacological
support

Heart rate

> 100 bpm

> 150 bpm

Erratic/ asystolic

Respiratory status

> 20 bpm PaCO2

Rapid, shallow,
crakles
PaCO2 > 45 mmHg

Requires intubations
and mechanical
ventilation and
oxygenation
Anuric, requires
dialysis
unconsciousness

<30 mm Hg
Urinary output

decreased

0.5 mL/kg/h

Mentation

confusion

lethargy

Acid-base balance

Respiratory
Alkalosis

Metabolic
Acidosis

Profuse acidosis

Shock

HYPOVOLEMIC

INTERNAL
FLUID LOSS

CIRCULATORY

CARDIOGENIC

LOSS OF
CARDIAC
PUMPING
ACTION

EXTERNAL
FLUID LOSS

ANAPHYLACTIC

SEPTIC
NEUROGENIC

HYPOVOLEMIC SHOCK

SEPTIC SHOCK

CARDIOGENIC SHOCK

NEUROGENIC SHOCK

Hypovolemic Shock

Decreased intravascular volume

15%- 30% of volume reduction

Example:
750 -1500 ml of blood loss in 70kg patient

Pathophysiology
Dec. blood volume
Dec. venous return
Dec. stroke volume
Dec. cardiac output

Dec. tissue perfusion

Risk Factor
External (fluid losses)

Trauma
Surgery
Vomiting
Diarrhea
Diuresis
Diabetes insipidus

Risk Factor
External (fluid losses)

Risk Factor
Internal (fluid losses)

Hemorrhage
Burns
Ascites
Peritonitis
Dehydration

Risk Factor
Internal (fluid losses)

Medical management

Fluid and blood replacement

Pharmacologic theraphy
>anti-emetic
>anti-diarrheal
>desmopressin

Nursing management
FOCUS: Primary Prevention of SHOCK
>proper positioning
>monitor V/s
>monitor I & O
>oxygenation

Cardiogenic Shock

Inability of the heart to contract and to

pump

Inadequate supply of oxygen to the heart

and tissue

Causes

Coronary

Most common
Ex. Acute MI

Non- Coronary

Stresses the myocardium

Hypoglycemia
Hypocalcaemia
Tension pneumothorax

Ineffective myocardial function

Cardiomyopathies
Cardiac tamponade
Dysrhythmias
Vulvular damage

Pathophysiology
Decreased cardiac
contraction

Decreased Stroke
Volume and CO

Pulmonary congestion

Decreased systemic
Perfusion

Decreased coronary
Artery perfusion

Medical management

Coronary

PCI
CABG
Intra aortic balloon
pump therapy

Non-coronary

Faulty cardiac valve

replacement
Correction of
dysrhytmias
Correction of acidosis
Treatment of tension
pneumothorax

Medical management

Oxygenation
Pain control
Hemodynamic monitoring
Fluid replacement
Pharmacologic therapy

Dobutamine
Nitroglycerine

Medical management

Pharmacologic therapy

Dobutamine
Nitroglycerine
Dopamine
Antiarhytmic

Mechanical assistive devices

Intra-aortic balloon counter pulsation

VADs
Total temporary artificial heart

Nursing management

ECG monitoring
Maintaining IABC
Enhancing safety and comfort

Prevent infection
Protect the skin
Proper positioning
Adm. Medication for pain

Circulatory shock

Blood volumes pools in peripheral blood

vessels
Types:

Septic
Anaphylactic
neurogenic