SHOCK

PRESENTED BY:
ROBERT SIENA
ERIC MACABIOG
 WHAT IS SHOCK?
• Shock is a potentially life-threatening condition that requires
immediate attention. It is a complex physiological phenomenon
that involves many organs of the body and it must be reversed
or death might occur.

• Shock is a term used to described the clinical syndrome that

develops when there is critical impairment of tissue perfusion
due to some form of acute circulatory failure (Davidson’s)

• Shock maybe defined as inadequate delivery of oxygen and

nutrients to maintain normal tissue and cellular function
(Schwartz’s)
The end result of any type of shock would be

• INADEQUATE O2

• INADEQUATE NUTRIENTS

• INADEQUATE REMOVAL OF WASTE PRODUCTS

 Stages of Shock
• Initial stage- initially ,the body compensates with
the onset shock .No changes are noted clinically .
Changes beginning to occur on the cellular level
• Compensatory stage- almost immediately, the
compensatory stage begins as the body’s
homeostatic mechanisms attempt to maintain
CO2, blood pressure, and tissue perfusion.
• Progressive stage- The compensatory mechanisms
begin failing to meet tissue metabolic needs, and
the shock cycle is perpetuated.
• Refractory stage- Shock becomes unresponsive to
therapy and is considered irreversible.
 CLASSIFICATION OF SHOCK
• Cardiogenic shock – it occurs due to systolic or
diastolic dysfunction
• Hypovolemic shock- it happens when there isn’t
enough blood in blood vessels to carry oxygen to
your organs. This can be caused by severe blood
loss
• Obstructive shock- it occurs when there is a
physical obstruction in blood flow
• Distributive shock -abnormal distribution of blood
flow in the small blood vessels results in
inadequate supply of blood to the body tissues
and organs
 There are number of type of distributive
shock including the ff.
• Anaphylactic shock-it is a complication of
severe allergic reaction known as anaphylaxis
or hypersensitivity reaction to a sensitizing
substance like
drug,chemical,vaccine,food,insect venom
• Septic shock- is due to bacterial infection
which release toxins leading to shock.
• Neurogenic shock- is caused by damage to
central nervous system, usually a spinal
injury .this causes blood vessels to dilate, and
the skin may feel warm and flushed .The heart
rate slows and blood pressure drops very low
 Clinical Manifestations
• Extremely low blood pressure
• Weakness
• Chest pain
• Weak Pulse
• Profuse sweating
• Dizziness
• Moist clammy Skin
• Unconsciousness
• Rapid ,shalow breathing
• Feeling anxious,agitated and confused
• Cyanosis
 DIAGNOSTIC EVALUATION
• History collection
• Physical Examination
• Blood culture &sensitivity test
• CBC increased WBC and ESR level
• Arterial blood gas analysis-Respiratory alkalosis
• ECG-dysarrthmias
• X-ray and CT scan
• Cardiac monitoring (SpO2,pulse Tempt are monitored
continuously)
• Central venous pressure- Fluid loss
Complications
• Loss of consciousness
• Respiratory failure
• Coagulation disorder
• Multi organ damage
• Coma
• Death
 Pharmacological Management
• Crytalloids: ringer’s solution and normal saline
solution
• Inotropic agents :Dopamine,Dobutamine and
Epinephrine
• Vasodilators :Nitroglycerine
• Diuretics: Lasilactone, Furosemide
• Antibiotics:Cifroploxacin and Amoxicillin and
Clavulanic acid
• Antihistamines: Epinephrine used in Prophylactic
shock
• Corticosteroids: Dexamethasone
• Sodium Bicarbobate: used to treat metabolic acidosis
• Bronchodilators; like Atropine, Aminophylline
 Non Pharmacological Management

• Modified tredelenberg position

• Assessment of Vital signs

• Oxygen Administration

• Parental Support
 Surgical Mgt
• Wound debriment- in case of chronic infected
wound,burns wound debridement to be done
for fast healing

• Angioplasty-in case of myocardial infarction

angioplasty can performed

• Tracheostomy
 Intermediate Nursing care Mgt
• Check for response
• Give rescue breath s or CPR as needed
• Lay the person flat, face-up, but do not move
him or her if you suspect a head, back or neck
injury
• Raise the person feet about 12 inches.Use a box
etc..If the raising the legs will cause pain or
further injury ,keep him or her flat,keep the
person still
• Do not raise the feet or move the legs if hip or leg
bones are brokenmKeep the person lying flat
• Check signs of circulation ,if absent begin CPR
• Keep the person warm and cofortable.Loosen belt and
tight clothing and cover the person with the blanket.
• NPO :Even if the person complains for thirst give
nothing by mouth .If the person wants water ,moisten
the lips
• Fluid and blood replacement.Open IV line on both
hands with two bore cannulas and fluid rapidly as
advised
• Administer oxygen via face mask
• Vaso activr medications to improve cardiac contractlity
(Dopamine,Dobutamine)