Shock
Explain what is meant by shock and how organs can react to this condition.
What is:
-widespread abnormal cellular metabolism that occurs when gas exchange with oxygenation and tissue perfusion needs are not met sufficiently to maintain cell function (too little O2 is delivered to the tissues)
-all body organs are affected
-organs can adapt by decreasing gas exchange and perfusion, or they can fail, leading to hypoxia
List the key GI symptoms of shock.
What is:
-decreased motility
-diminished or absent bowel sounds
-nausea, vomiting
-constipation
Describe the pathophysiology of hypovolemic shock.
What is:
-decreased volume of circulating blood in the body that decreases MAP, resulting in inadequate total body perfusion and gas exchange
-results from depleted intravenous volume, either by extracellular fluid loss or blood loss
Describe the early signs of shock.
What is:
-increased HR, increased RR, increased diastolic BP
-During initial phase of shock, use change in pulse rate/quality as an indicator of shock.
Describe objective shock, its clinical manifestations, and treatments of possible causes.
What is:
-happens when a blockage in the CV system keeps blood from flowing to the body's tissues and organs
-heart is normal but conditions outside of heart prevent adequate filling of the heart or adequate contractions of the healthy heart muscle
-increased RR, increased HR, decreased BP, decreased temp, decreased urine output
-pale, cool extremities, muffled heart sounds, JVD, decreased LOC, signs of poor perfusion
-Treatment: O2
A patient has hives, wheezing, and low BP after eating peanuts. What type of shock?
What is anaphylactic shock?
List the pathophysiology of shock in order of progression.
What is:
-initial insult, commonly resulting in circulatory failure
-impaired O2 delivery, leading to tissue hypoxia
-anaerobic metabolism (pyruvate to lactate conversion and decreased ATP production)
-failure of cells to maintain osmotic, ionic, and pH homeostasis
-cellular swelling and death
-activation of inflammatory cascades and microvascular alternations
-organ dysfunction/shock
List the key neuromuscular symptoms of shock.
What is:
-Early S/S: anxiety, restlessness, thirst
-Late S/S: lethargy, coma, weakness, decreased DTR, sluggish pupils
List the signs and symptoms of hypovolemic shock.
What is:
-increased sympathetic response, resulting in increased HR, and increased peripheral vasoconstriction
-increased RR, decreased BP, weak pulse
-cool, clammy skin
-decreased urine output
-anxiety, thirst, dizziness, weakness, syncope
Describe the compensatory signs of shock.
What is:
-vasoconstriction, decreased pulse pressure, increased HR
-decreased pH, PsO2 90-95%, tissue hypoxia, cool extremities
-dry mouth, thirst, increased K+
-restlessness, apprehensiveness, may be misdiagnosed as a panic attack
Describe cardiogenic shock signs and symptoms along with treatment.
What is:
-increased RR, increased HR, decreased BP, decreased urine output
-pallor, cool and clammy skin, chest discomfort, syncope, JVD, pulmonary edema, orthopnea
- O2
-Keep warm
- elevate legs
After a motorcycle crash, a patient has no feeling in their legs and low BP.
What is neurogenic shock?
Shock caused by infection
What is septic shock?
List the key renal S/S of shock.
What is:
-decreased urine output
-increased urine specific gravity
-sugar or acetone in urine
Describe the treatment necessary for hypovolemic shock.
What is:
-O2 therapy
-monitor vitals, LOC
-ensure patent airway
-elevate feet and lay head flat or <30 degrees
Describe the progressive signs of shock.
What is:
Anxiety or agitation/restlessness
Pale, cool, clammy skin
Rapid heart rate
Rapid breathing
Weak or thready pulse
Nausea or vomiting
Later Progressive signs:
Low blood pressure
Confusion or disorientation
Weakness or fatigue
Decreased urine output
Bluish lips and fingernails (cyanosis)
Unconsciousness
Organ failure
Shock that occurs due to a spinal cord injury
What is neurogenic shock?
Elderly patient with pneumonia, fever, low BP, and confusion.
What is septic shock?
This pulse characteristic is often present in shock
What is weak and thready?
List the key integumentary symptoms in shock.
What is:
-cold, mottled skin
-pallor, cyanosis
-dry mouth, pastelike coating
-decreased cap refill
Describe the inotropic agents used to treat hypovolemic shock.
What is:
-Inotropes stimulate beta-adrenergic receptors on the heart, improves contractility
-Dobutamine: assess for chest pain, monitor for transient hypotension
-Milrinone: assess for hypotension, check BP every 15 mins for HTN (overdose)
A narrowing difference between systolic and diastolic pressure indicates this.
What is a falling pulse pressure?
Describe distributive shock, causes, and treatment.
What is:
-blood volume is not lost from body, but is distributed to the interstitial tissues where it cannot perfuse organs
-includes sepsis and anaphylaxis
-caused by: spinal cord injury, head trauma, chemical-induced, pain, stress, burns, capillary leak, liver impairment, hyperproteinemia
-Treatment: tailored to what causes it, maintain patent airway
MVA victim is unconscious, hypotensive, tachycardic, and has bruising on chest.
What is cardiogenic shock?
Persistent bradycardia and hypotension are hallmarks of this type of shock
What is neurogenic shock?
List the key cardiovascular symptoms associated with shock.
What is:
-decreased cardiac output
-increased heart rate, thready pulse
-decreased blood pressure, narrowed pulse pressure
-postural hypotension
-flat neck/hand veins
-slow cap refill
-diminished peripheral pulses
Describe the vasoconstrictors used for hypovolemic shock.
What is:
-improve MAP by increasing peripheral resistance, venous return, contractility
-Norepinephrine: assess for chest pain
-Phenylephrine HCl: monitor urine output hourly for decreased urine, assess BP every 15 mins for HTN, assess for headache (drug excess), assess for extravasation every 30 mins, check color of extremities, assess for chest pain
Systolic blood pressure significantly below normal for age (e.g., below 90 mmHg in adults
What is decompensated shock
Describe anaphylactic shock, S/S, and treatment.
What is:
-caused by severe allergic reaction
-RR can be increased or decreased, increased HR, decreased BP, skin flushed, swollen, itchy, priuritis, decreased urine output, decreased LOC, bronchoconstriction
-Tx: epinephrine, steroids, antihistamines
-maintain patent airway
A patient with GI bleeding is pale, hypotensive, and weak.
What is hypovolemic shock?
This is the priority for managing a trauma patient in hemorrhagic shock.
What is bleeding control?
List the key respiratory symptoms associated with shock.
What is:
-increased shallow RR
-PaCO2 increases, then decreases
-cyanosis of lips/nails
There is no significant external bleeding, other causes for hypovolemic shock?
What is:
diabetic ketoacidosis, severe diarrhea and vomiting, burns or heatstroke
Capillary refill time greater than this suggests poor perfusion.
What is 2 seconds?
Describe septic shock, S/S, and treatment.
What is:
-massive vasodilation, decrease systemic vascular resistance
-blood clots form, decreased BP, increased RR, increased HR, increased or decreased temperature, increased urine output, bounding pulse, altered LOC, skin is flushed then pale and cool
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This piece of equipment is critical for oxygen delivery in shock
What is a non-rebreather mask?