-
two criterian that must be met before shock can be diagnosed is
- a reduction in mean systemic b/p
- clinical evidence of hypoperfusion of vital organs
- earliest sighn is agitation and restlessness
- decreased uop and mentation and b/p
- cool clammy skin
- increased pulse
-
what is the formula for map
dbp(2)+sbp
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what happens in the initial stage of shock
- increased sns stim
- mild vasoconstriction and increase in hr
-
what happens in the compensated or nonprogressive stage of shock
- organs still adequately perfused because of compensatory mech
- decrease in map 10-15 degress from baseline continued decrease in bp
- activation of raas and resulting decreased uop
- moderate vasoconstriction with still increase in hr
- blood shunted to heart and vital organs
-
what happens in the decompensated or progressive stage of shock
- underperfusion of organs and compensatory mech fail
- map decreased by over 20 from baseline
- anoxia
- hypoxia
-
what happens in the irreversible or refratory shock stage
- severe hypoxia and ischemia
- mods
- death
-
wha is hypovolemic shock
volume loss
-
compare and contrast absolute vs relative volume loss
absolute is going outside the body
ie: frank bleeding,diarrhea or vomiting,diuresis,loss of plasma through skin (burns)
- relative is staying inside
- as in third spacing, internal volume loss and fluid shifting
-
what is the order of the cascade of hypovolemic shock
- decreased
- circulating volume --preload(venous return)-- stroke volume--co--cellular 02 supply--tissue perfusion
-
what is the classification system of hypovolemic shock
class I-IV
-
what is class I
volume loss up to 15% or 750ml
- charecterized by
- anxiety
- restlessness
- poss be asymptomatic
-
what is class II
- beginning of changes in vs
- blood loss of 15-30% or 750-1500ml
- characterized by
- decreased preload
- apprehension/ restlessness
- pallor/diaphoresis
- delayed cap refill
- decreased uop
- increased hr >100and rr 20-30
-
what is class III
- volume loss of 30-40% or 1500-2000 ml
- characterized by
- decreased b/p, and increased hr and rr and uop
- delayed cap refill
- anxious and confused
-
what is class IV
- hemorrahage
- volume loss of greater than 40% and 2000ml
- mods
- irreversible shock
-
how do you tx hypovolemic shock
- blood - prefer prbc
- (can use whole blood but rarely used due to allergic reactions)
-
what is cardiogenic shock
- pump failure
- low co and hypotension
- low uop
- decreased peripheral pulses
- cool clammy skin
- ms changes
-
causes of cardiogenic shock
- ischemia, structural problems and dysrhythmias
- MI
- will hear crackles
- likely within 48 hours of MI
-
what is the cascade cycle in cardiogenic shock
decreased heart fnxn--decreased co--decreaded b/p and hypoperfusion with hypoxemia--decreased in blood supply and further dysfunction--compensatory mech increase b/p--creates increased oxygen demand and work of the heart
-
s/s of cardiogenic shock
pulmonary edema, peripheral edema and jvd, mottlling of skin
-
assesment findings with cardiogenic shock
- L ventricle ejection fraction <30%
- hypotension
- increased rr
- crackles resulting from pulmonary congestion
- decreased uop
- restlessness, agitation, confusion
-
what needs to be done to reach the goal of restoring blood flow in cardiogenic shock
- thrombolytics
- angioplasty
- coronary revascularization
- iabc to increase perfusion and decrease afterload (inflates durin diastole and deflates during systole)
-
what drugs are given with cardiogenic shock
- pos inotrope
- dobutamine (preferred because no much chrono effect)
- dopamine
- vasoactive
- nitro - decrease preload (blood coming back to heart)
-
distributive shock develops as a result of...
vasodilation without an increase in intravascular volume
-
3 types of distributive shock
septic, anaphlatic and neurogenic
-
what is the differing charecteristic in septic shock
infection
-
2 of the following assesment vitals and or labs must be met to be declared in sepsis
icreased b/p, hr, rr, wbc
-
what is sepsis with hypotension
- b/p<90 despite fluid resuscitaion
- scant urination
- change in ms
-
what is the cascade of events in septic shock
microbes invade--endotoxins release cytokines initiating inflamm response--damages vessel triggering coag cascade and thrombi--fibrinolysis is interupted blocking blood flow--also increased cap perm creating edema
-
what are the 2 states of septic shock
early-hyper and late-hypo dynamic state
-
what assesment findings during early-hyperdynamic state
- normal to high co
- high temp
- tachypnea
- hypotension to normotension
- vasodilation and b/p is barely maintained
-
what assesment findings during late hypodynamic state
- low perfusion, co,
- ms changes
- clammy pale skin
- tachycardia
- pulmonary congestion
- central cyanosis
-
what is the overall goal with septic shock
- filling the tank and constricting the vessels 1st
- eliminating hte source of infection
-
filling the tank and constricting the vessels in septic shock is done with
- iv fluids ie
- ns,lr
- vasoconstrictors
- dopamine
-
what is the cascade of events from anaphylactic shock
allergic reaction--mast cells and histamine--increased vasc perm--edema and bronchoconstriction
-
clinical manifes of anaphlactic shock
- priurtis, sneezing/coughing, wheezing uticaria, angioedema,restlessness
- BAD - stidor, bronchospasm and laryngeal edema
-
more resulting from anaphlactic shock
increased cap perm--pooling of blood in periphery-- decrease co and b/p--decrease in svr
-
management of anaphlactic shock
- abc'c
- epi
- volume expansion
- vasoconstrictor agents
- antihistamines
- bronchodilators
- corticosteriods
-
pathophys of neurogenic shock
- loss of sympathetic tone--massive vasodilation--
- decreased venous return,sv,co, oxygen supply, tissue perfusion
-
what is the differing characteristic with neurogenic shock
BRADYCARDIA
-
poikilothermia happens in neurogenic shock as a result of loss of vasomotor tone, define this
pt assumes temp of environment
-
presenting s/s with neurogenic shock include
hypotension, hypothermia, decreased uop, ms changes, increased cap refill time
-
tx of neurogenic shock
- stabilize spine
- abc's
- fluid resusitation
- vasoconstrictors
- atropine for bradycardia
- warming blankets for hypothermia
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