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General Shock- Applies to all types. Cause: 1. 2. 3. Loss of blood volume Massive vasodilation Heart failure (to pump the blood)
*with any type of shock: decreased Cardiac Output , blood, and O2 to tissues and organs. FYI: *Shock is based on the individual’s V/S and symptoms. *Always obtain baseline V/S! example: Pt. has a B/P of 80/40... Are they in shock? It depends. A low B/P may be normal. Compare it to the baseline to be sure. *A drop in blood pressure decreases urinary output- characteristics of all types of shock. 4 Types of Shock
D/t low circulating blood volume (most common)
Causes: 1. Anything that depletes blood volume 2. Trauma (gunshot, Stabbing, ect.) 3. Anticoagulants (Heparin, Coumadin (can bleed internally)) 4. Diuretics 5. Dehydration 6. Third spacing (fluid into tissues) 7. Draining wounds and burns 8. Diabetes Insipidus (Deals with a decreased amt. of ADH in the body.) Signs and Symptoms of Hypovolemic Shock 1. Decreased Loss of Consciousness 2. Tachycardia (pulse: weak and thready) 3. Decreased B/P 4. Decreased Cardiac Output (CO= SV x HR) 5. Decreased Urinary Output 6. Cool, Clammy Skin
Deals with the heart itself.
Cause 1. Myocardial Infarction (MI/ heart attack)
Decreased O2 to an area (Ischemia) Death of tissue (necrosis)
2. Decreased Cardiac Output 3. Decreased B/P
Because heart can’t pump the blood.
occurs when the heart or vessels are obstructed/compressed.
Example: Cardiac Tamponade: occurs with fluid buildup within the pericardial sac that surrounds the heart. The fluid compresses on the heart and prevents the heart from pumping adequately. Example: Tension Pneumothorax: occurs when the lung is compressing on the heart. Prevents the heart from pumping adequately.
Classic characteristic is massive vasodilation Quick refresh (Medulla controls the heart) Example: B/P medication overdose: there would be no fluid loss, however peripheral resistance is decreased. (vasodilation) therefore, blood is redistributed throughout the body. Three types of Distributive Shock
Causes 1. Damage to vasomotor center of the brain (medulla)
Vessels lose peripheral resistance.
2. Spinal cord injuries 3. Overdose of opoids, tranquilizers, and anesthetics
Depresses the CNS and lowers the respiratory rate
Refresher (Narcan is the antidote for opoid overdose)
Signs/Symptoms of Neurogenic shock 1. Decreased LOC 2. Bradycardia 3. Hypotension 4. Warm, Dry Skin 5. Decreased Respiratory Rate 6. Decreased Urinary Output
Vessels are closer to surface due to massive vasodilation
Characteristics: Bacterial infection that spreads to the blood. The most
common infection is Gram-negative bacteria (ex: E-coli) FYI: Septicemia/bacteremia- bacteria in the blood.
Cause 1. Tampon Misuse 2. Soft-tissue injuries *Bacteria releases endotoxins that cause vasodilation of the blood vessels.
Endotoxins stimulate cystokines that increase capillary permeability and allows fluid to seep into tissues. *
Signs/Symptoms of Septic/Toxic Shock 1. Decreased LOC 2. Tachycardia 3. Fever 4. Skin: dry and warm 5. Increased WBC count due to infection 6. Rash 7. Desquamation (peeling of the palms)(reddened) 8. Decreased Urinary Output 9. Decreased B/P 10. Decreased Cardiac Output
* FYI: staph and strep are two types of gram-positive bacteria* C>
caused by allergy (hypersensitivity caused by the antigen/antibody reaction)
(Pt. should wait 30 min. post injection before leaving the office/hospital) Antidote: epinephrine (Epi-pen) * Mast cells release histamine (produces inflammation and causes massive vasodilation of the vessels, increases permeability which causes fluid to seep into tissues. Causes bronchi constriction (airway swells) ) causing hives, itching, and rash.*
Example: Peanuts, Penicillin
Treatments for Anaphylactic Shock Medications 1. Epinephrine (adrenaline): dilates airway and increases B/P 2. Benadryl (antihistamine) 3. SoluMedrol (steroid): reduces inflammatory response
3 Stages of Shock
A. Catecholamine release (epinephrine and nor-epinephrine)
-Dilates airway and increases blood pressure B. Renin Angiotensin Aldosterone Mechanism C. ADH is released from the posterior pituitary to save water D. Corticosteroids released to retain fluid (glucocorticoids) E. ACTH (released from the posterior pituitary) stimulates the adrenal cortex to release glucocorticoids (cortisol)
*Glucocorticoids* 1. Saves water 2. Increases blood glucose 3. Decreases inflammation 4. Decreases immune response
F. Mineralcorticoids saves potassium and excretes sodium and water
A. Hypoxia- Decreased O2-> switches cell-> anaerobic metabolism occurs
which leads to metabolic acidosis due to an increase in lactic
B. Cellular Damage- Sodium enters the cell, potassium exits the cell->
cell ruptures and the lysosomes destroy the cell
C. Coagulation defects- micro emboli from blood clots cause blood clots
to stick together
D. Cardiovascular Changes E. Aggressive treatments are required to bring Pt. out of this stage * The earlier shock is treated, the better chance of survival*
Involves multiple organ damage and/or shutdown. Late signs: Cyanosis, Mottling (bluish color to areas to the skin)
* Use of Doppler to obtain BP. If you can’t get one use a stethoscope * Palpable peripheral pulse - systolic pressure is less than 80mmHg * Pulse Pressure (notm is 30-50) In shock, pulse pressure narrows to less
than 30 *
Capillary Refill is greater than 3 seconds. Hypoxia causes heart
arrhythmias (arterial lines measure B/P more accurately)
Two early signs of shock: Decreased LOC and Tachycardia
1. ABG 2. CVP pressure- 2-7 mmHg; 4-7 cmH2O- measured in the ® atrium
(Swanz-Ganz-catheter is used for this procedure)
3. PaO2- (80-100) In shock it is less than 60 4. CO2- Normal or decreased 5. O2 sat.- (95%- 100%) If PaO2 is at least 60, pulse ox is 90% Hypovolemic Shock- CVP increased Cardiogenic Shock - CVP decreased 6. PAP (pulmonary artery pressure)- 20-30/8-12
decreased or low when in shock
7. PCWP (pulmonary capillary wedge pressure) 4-12 mmHg
pressure on (L) side of the heart measured from the ® side of heart Decreased or reduced when in shock
Normal pulse- 60-100 Normal cardiac output- 5L/min Pulse is reduced (below 60), it lowers the cardiac output If the pulse is elevated (above 100), it also lowers cardiac output!!
(The heart does not give the ventricles adequate time to fill, resulting in a lower cardiac output!)