SHOCK

- Is an acute, life-threatening condition in which body tissues are inadequately perfused or unable to utilize
oxygen.

Types of Shock:
1. Hypovolemic - inadequate amounts of blood volume in the intravascular space
2. Cardiogenic –the heart unable to pump enough blood
3. Obstructive –blood flow is impeded by a mechanical or physical obstruction.
4. Distributive – involves alterations in the distribution of intravascular volume.
Neurogenic – severe pain
Anaphylactic – systemic allergy
Septic – systemic infection

Stages of Shock:
1.   Compensated / non-progressive
 Vital organs remain adequately perfused
2.   Decompensated / progressive
 Vital organs become underperfused
 Compensatory mechanisms become ineffective, resulting in systemic manifestation
3.   Irreversible
 Therapeutic interventions become useless
 Death eventually occurs

Physiologic Responses to Shock:

o Vasoconstriction
o Compensatory mechanism
o SNS activation
o Tachycardia
o Tachypnea
o Skin color and temperature changes
o Early : cool and pale
o Late : cyanosis

o Hypotension: compensatory mechanisms fail

o Coagulation abnormalities
o Microaggregates of platelets and clotting factors accumulate in the capillary bed, resulting on clotting.
o Thrombocytopenia may occur in septic shock
o Hyperglycemia
o Glycogen is broken down into glucose
o Fluid shifts
o Activation of the RAAS.

End organ damage:

o Kidney problems
o Hepatic dysfunction
o GI problems
o Nutritional deficits
o CNS Damage

First Aid and Preventive Management

o Proper Position
o Supine (Safe position)
o Modified Trendelenburg (Improves blood circulation)
o High-Fowler’s (difficulty of breathing)
 o Sidelying (Recovery position)- nauseated or vomiting victim

Proper Body Heat

o Maintain body temperature (must not be perspiring nor chilling).

Overall Management Strategies in Shock

A. Fluid replacement to restore intravascular volume
B. Vasoactive medications to restore vasomotor tone and improve cardiac function
C. Nutritional support to address the metabolic requirements that are often dramatically increased in
shock

Collaborative Management:
 Assess the primary cause of shock
 Monitor:
o intake and output
o CVP
o vital signs
 Maintain airway and provide cardiac and pulmonary support.
 IVF as ordered.
 Administer the following as ordered:
o Analgesics: Morphine Sulfate
o Antihistamines
o Steroids
 Administer blood transfusion as indicated.
 Institute management for specific cause
 Provide supportive care as indicated.