CABANILLA, Jersey Kaye NCMB314

1. Describe the physical manifestations most commonly associated with the various shock
states.
WHAT IS SHOCK?
Shock is a life-threatening medical condition as a result of insufficient blood flow throughout the
body. Shock often accompanies severe injury or illness. Medical shock is a medical emergency
and can lead to other conditions such as lack of oxygen in the body's tissues (hypoxia), heart
attack (cardiac arrest) or organ damage. It requires immediate treatment as symptoms can worsen
rapidly.

Medical shock is different than emotional or psychological shock that can occur following a
traumatic or frightening emotional event.
WHAT ARE THE 5 TYPES OF SHOCK?

Septic shock results from bacteria multiplying in the blood and releasing toxins. Common
causes of this are pneumonia, urinary tract infections, skin infections (cellulitis), intra-
abdominal infections (such as a ruptured appendix), and meningitis.

Anaphylactic shock is a type of severe hypersensitivity or allergic reaction. Causes

include allergy to insect stings, medicines, or foods (nuts, berries, seafood), etc.

Cardiogenic shock happens when the heart is damaged and unable to supply sufficient blood to
the body. This can be the end result of a heart attack or congestive heart failure.

Hypovolemic shock is caused by severe blood and fluid loss, such as from traumatic bodily
injury, which makes the heart unable to pump enough blood to the body, or severe anemia where
there is not enough blood to carry oxygen through the body.

Neurogenic shock is caused by spinal cord injury, usually as a result of a traumatic accident or
injury.
WHAT ARE THE SYMPTOMS OF SHOCK?

low blood pressure and rapid heart rate (tachycardia) are the key signs of shock.

Symptoms of all types of shock include:

 Rapid, shallow breathing

 Cold, clammy skin
 Rapid, weak pulse
 Dizziness or fainting
 Weakness

Depending on the type of shock the following symptoms may also be observed:

 Eyes appear to stare

 Anxiety or agitation
 Seizures
 Confusion or unresponsiveness
 Low or no urine output
 Bluish lips and fingernails
 Sweating
 Chest pain

2. Describe prevention approaches that can be instituted in the critical care environment.

Depending on the type or the cause of the shock, treatments differ. In general, fluid resuscitation
(giving a large amount of fluid to raise blood pressure quickly) with an IV in the ambulance or
emergency room is the first-line treatment for all types of shock. The doctor will also administer
medications such as epinephrine, norepinephrine, or dopamine to the fluids to try to raise a
patient's blood pressure to ensure blood flow to the vital organs.
Tests (for example, X-rays, blood tests, EKGs) will determine the underlying cause of the shock
and uncover the severity of the patient's illness.

Septic shock is treated with prompt administration of antibiotics depending on the source and
type of underlying infection. These patients are often dehydrated and require large amounts of
fluids to increase and maintain blood pressure.

Anaphylactic shock is treated with diphenhydramine (Benadryl), epinephrine (an "Epi-pen"),

steroid medications methylprednisolone (Solu-Medrol), and sometimes a H2-Blocker
medication (for example, famotidine [Pepcid], cimetidine [Tagamet], etc.).

Cardiogenic shock is treated by identifying and treating the underlying cause. A patient with a
heart attack may require a surgical procedure called a cardiac catheterization to unblock an
artery. A patient with congestive heart failure may need medications to support and increase the
force of the heart's beat. In severe or prolonged cases, a heart transplant may be the only
treatment.

Hypovolemic shock is treated with fluids (saline) in minor cases, but may require multiple blood
transfusions in severe cases. The underlying cause of the bleeding must also be identified and
corrected.

Neurogenic shock is the most difficult to treat. Damage to the spinal cord is often irreversible
and causes problems with the natural regulatory functions of the body. Besides fluids and
monitoring, immobilization (keeping the spine from moving), anti-inflammatory medicine such
as steroids, and sometimes surgery are the main parts of treatment.

Self-Care at Home

 Call 911 for immediate medical attention any time a person has symptoms of shock. Do
not wait for symptoms to worsen before calling for help. Stay with the person until help
 arrives, and if possible, stay on the line with the 911 dispatcher because they may have
specific instructions for you.
 While waiting for help or on the way to the emergency room, check the
person's airway, breathing and circulation (the ABCs). Administer CPR if you are
trained. If the person is breathing on his or her own, continue to check breathing every 2
minutes until help arrives.
 Do NOT move a person who has a known or suspected spinal injury (unless they are in
imminent danger of further injury).
 Have the person lie down on his or her back with the feet elevated above the head (if
raising the legs causes pain or injury, keep the person flat) to increase blood flow to vital
organs. Do not raise the head.
 Keep the person warm and comfortable. Loosen tight clothing and cover them with a
blanket.
 Do not give fluids by mouth, even if the person complains of thirst. There is a choking
risk in the event of sudden loss of consciousness.
 Give appropriate first aid for any injuries.
 Direct pressure should be applied to any wounds that are bleeding significantly.

3. How does the heart work?

The heart is at the center of your circulatory system, which is a network of blood vessels that
delivers blood to every part of your body. Blood carries oxygen and other important nutrients
that all body organs need to stay healthy and to work properly.
Your heart is a muscle, and its job is to pump blood throughout your circulatory system.

How does my heart pump blood?

Your heart is divided into two separate pumping systems, the right side and the left side.
 The right side of your heart receives oxygen-poor blood from your veins and pumps it to
your lungs, where it picks up oxygen and gets rid of carbon dioxide.
  The left side of your heart receives oxygen-rich blood from your lungs and pumps it
through your arteries to the rest of your body.
Your heart has four separate chambers that pump blood, two on the right side and two on the left.

How does blood flow through the heart?

Blood flows through your heart and lungs in four steps:
1. The right atrium receives oxygen-poor blood from the body and pumps it to the right
ventricle through the tricuspid valve.
2. The right ventricle pumps the oxygen-poor blood to the lungs through the pulmonary valve.
3. The left atrium receives oxygen-rich blood from the lungs and pumps it to the left ventricle
through the mitral valve.
4. The left ventricle pumps the oxygen-rich blood through the aortic valve out to the rest of the
body.
The left and right atria are smaller chambers that pump blood into the ventricles. The left and
right ventricles are stronger pumps. The left ventricle is the strongest because it has to pump
blood out to the entire body. When your heart functions normally, all four chambers work
together in a continuous and coordinated effort to keep oxygen-rich blood circulating throughout
your body. Your heart has its own electrical system that coordinates the work of the heart
chambers (heart rhythm) and also controls the frequency of beats (heart rate).

How does my heart maintain its normal function?

The task of your heart is to pump enough blood to deliver a continuous supply of oxygen and
other nutrients to the brain and the other vital organs. To do this, your heart needs to:

 Regulate the timing of your heartbeat. Your heart's electrical system controls the timing

of the pump. The electrical system keeps your heart beating in a regular rhythm and adjusts
the rate at which it beats. When the electrical system is working properly, it maintains a
normal heart rate and rhythm. Problems with this electrical system can cause an arrhythmia,
which means that your heart chambers are beating in an uncoordinated or random way or
that your heart is beating too fast (tachycardia) or too slow (bradycardia).

 Keep your heart muscle healthy. The four chambers of your heart are made of a special
type of muscle called myocardium. The myocardium does the main pumping work: It
relaxes to fill with blood and then squeezes (contracts) to pump the blood. "Contractility"
describes how well the heart muscle squeezes. After pumping, your heart relaxes and fills
with blood. The muscle must be able to relax enough so that it can fill with blood properly
before it pumps again. The health of your heart muscle affects both its contractility and its
ability to relax, both of which determine whether your heart is able to pump enough blood
each time it beats. Problems with the contractility of your heart can be caused by problems
with the muscle itself (such as a viral infection of the heart muscle or an inherited heart
muscle disorder) or by problems with the blood supply to the heart muscle (such as reduced
 blood flow to the heart muscle, called ischemia). Your heart muscle needs its own supply of
blood because, like the rest of your body, it needs oxygen and other nutrients to stay
healthy. For this reason, your heart pumps oxygen-rich blood to its own muscle through
your coronary arteries.

 Keep blood flowing efficiently. Your heart has four valves that control the flow of blood in
and out of the chambers. There are valves between the atrium and the ventricle on each side
of your heart. There is also a valve controlling the flow of blood out of each of your
ventricles. The valves are designed to keep blood flowing forward only. When each
chamber contracts, a valve opens to allow blood to flow out. When the chamber relaxes, the
valve closes to prevent blood from leaking back into the chamber and to allow the chamber
to fill with blood again. A problem with your heart valves can disrupt the normal flow of
blood and cause problems for your heart.

5. What causes of increased preload of the blood?

Preload can be defined as the initial stretching of the cardiac myocytes prior to contraction. 
Preload, therefore, is related to muscule sarcomere length. Because sarcomere length cannot be
determined in the intact heart, other indices of preload are used such as ventricular end-diastolic
volume or pressure.

When venous return to the heart is increased, the end-diastolic pressure and volume of the
ventricles are increased, which stretches the sarcomeres, thereby increasing their preload. In
contrast, hypovolemia resulting from a loss of blood volume (e.g., hemorrhage) leads to less
ventricular filling and therefore shorter sacromere lengths (reduced preload). Changes in
ventricular preload dramatically affect ventricular stroke volume by what is called the Frank-
Starling mechanism. Increased preload increases stroke volume, whereas decreased preload
decreases stroke volume by altering the force of contraction of the cardiac muscle.

The concept of preload can be applied to either the ventricles or atria. Regardless of the chamber,
the preload is related to the chamber volume, and therefore sarcomere length, just prior to
contraction.
Ventricular filling and therefore preload is increased by:
1. Increased central venous pressure that can result from decreased venous
compliance (e.g., caused by sympathetic activation of venous smooth muscle) or
increased thoracic blood volume. The latter can be increased by either increased
total blood volume or by venous return augmented by increased respiratory
activity, increased skeletal muscle pump activity, or by effects gravity (e.g., head-
down tilt).
2. Increased ventricular compliance, which results in a greater expansion of the
chamber during filling at a given filling pressure.
3. Increased atrial force of contraction resulting from sympathetic stimulation of the
atria or from increased filling of the atria and therefore increased atrial contractile
force through the Frank-Starling mechanism.
4. Reduced heart rate, which increases ventricular filling time.
5. Increased aortic pressure, which increases the afterload on the ventricle, reduces
stroke volume by increasing end-systolic volume, and leads to a secondary increase
in ventricular preload.
6. Pathological conditions such as ventricular systolic failure and valve defects such
as aortic stenosis, and aortic regurgitation (pulmonary valve
stenosis and regurgitation have similar effects on right ventricular preload).

6. What causes of decreased preload of the blood?

Ventricular preload is decreased by:
1. Decreased venous blood pressure, most commonly resulting from reduced blood
volume (e.g., hemorrhage) or gravity causing blood to pool in the lower limbs
when standing upright.
 2. Impaired atrial contraction that can result from atrial arrhythmias such as atrial
fibrillation.
3. Increased heart rate (e.g., atrial tachycardia), which reduces ventricular filling time.
4. Decreased ventricular afterload, which enhances forward flow (i.e., ejection)
thereby reducing end-systolic volume and end-diastolic volume secondarily.
5. Ventricular diastolic failure (decreased ventricular compliance) caused, for
example, by ventricular hypertrophy or impaired relaxation (lusitropy).
6. Inflow (mitral and tricuspid) valve stenosis, which reduces ventricular filling.

REFERENCES:
https://www.medicinenet.com/shock/article.htm
https://www.uofmhealth.org/health-library/tx4097abc#:~:text=The%20right%20side
%20of%20your,the%20rest%20of%20your%20body.
https://www.cvphysiology.com/Cardiac%20Function/CF007