Week 7- shock Flashcards
(29 cards)
Shock Pathophysiology: Compensatory Stage
The patient experiences compensatory mechanisms, decreased CO stimulates baroreceptors, releases adrenaline and noradrenaline, maintains essential organs, decreases blood flow to kidneys, GIT, lungs, skin, activates renin-angiotensin-aldosterone system, and releases ADH. If corrected patient can recover from this stage
Shock Pathophysiology: Progressive stage
The condition causes a failure of compensatory mechanisms, leading to decreased ATP production, hypoxia, cellular perfusion, and tissue ischemia. It increases the risk of gastric ulceration, bleeding, and acute renal failure. Aggressive management required to prevent multiple organ dysfunction syndrome (MODS)
Shock Pathophysiology: Irreversible / Refractory stage
○ Compensatory mechanisms are overwhelmed
○ Severe tissue hypoxia with ischemia, necrosis and death of the cell occurs
○ Build up of toxins
○ Multi-organ failure
○ Recovery unlikely
Classification of Shock
Four types of shock are recognised:
- Hypovolaemic shock (loss of intravascular volume)
- Cardiogenic shock (pump failure)
- Distributive shock (systemic vasodilation)
- Obstructive shock (physical obstruction of blood circulation)
Hypovolaemic Shock
caused by a loss of fluid. This can be from whole blood (haemorrhage), plasma (burns) or interstitial fluid (vomiting, diaphoresis). Shock begins to develop when the total circulating volume is decreased by approximately 15%.
Clinical manifestations of hypovolaemic shock may be:
- Restless, anxious, confused, agitated
- Tachypnoea
- Hypotension (patients may initially be hypertensive when compensation occurs)
- Tachycardia
- Weak thready or absent peripheral pulses
- Poor skin turgor
- Cool, pale, moist skin
- Decreased UO
- Marked thirst
- Acidosis
Hypovolaemic Shock: assessment and management. Danger
- Assess and intervene as required - this could relate to absolute fluid loss or haemorrhage
Hypovolaemic Shock: assessment and management. Response
- Assess and monitor conscious state
Hypovolaemic Shock: assessment and management. send for help
- Where abnormal findings in Danger and Response, consider sending for help
- Colleagues
- Local Help
- MET Call
- Code Blue
Hypovolaemic Shock: assessment and management. airway
- Assess and monitor patency
- Interventions:
- Consider suction
- Consider airway adjuncts as required
- Secure airway if required
- If trauma involved consider cervical spine immobilisation
Hypovolaemic Shock: assessment and management. breathing
- Assess: RR, WOB, SpO2 , ABGs
- Interventions:
- Oxygen 10 – 15L via Hudson mask
- Positioning
Hypovolaemic Shock: assessment and management. circulation
Assess
* Source of fluid loss,
* HR, BP, Cap refill, Peripheral pulses, U/O, ECG/CCM
Interventions
* Control external bleeding – or fluid loss
* Two large bore IVC
* Fluid resuscitation
* May require inotropes to improve cardiac output (CO) until bleeding/fluid loss is stopped
* May required invasive HDM
* Consider the need for a CVC
Hypovolaemic Shock: assessment and management. disability
Assess
* GCS/ level of consciousness
* Anxiety
* Temperature (can be assessed in circulation, disability or exposure)
* BGL
Interventions
* BGL – if altered manage
* If altered LOC – consider airway compromise
* Always consider and treat hypoxia (identified in breathing)
Cardiogenic Shock
occurs from cardiac pathology causing inadequate cardiac output leading to tissue hypoxia. Cardiogenic shock occurs in the presence of adequate intravascular volume.
The causes of cardiogenic shock are:
- Reduced contractility
- Inadequate filling
- Arrhythmia
- Failure of forward flow
Clinical manifestations that may be present in cardiogenic shock are:
- Increased respiratory rate (RR)
- Increased work of breathing (WOB)
- Possible crackles or acute pulmonary oedema (APO) on chest auscultation
- Tachycardia
- Hypotension
- Distended neck veins (raised JVP)
- Cool, clammy, pale skin
- Prolonged capillary refill time
- Decreased urine output
- Confusion
- Anxiety
Cardiogenic Shock: airway
- Assess and maintain patency
Interventions - Secure airway if required
Cardiogenic Shock: breathing
- Assess: RR, WOB, SpO2, Tachypnoea
- ↑ WOB
- Possible APO / crackles
Interventions - Provide supplemental oxygen +/- CPAP
- Ongoing monitoring
Cardiogenic Shock: circulation
- Assessment: HR, BP, Cap refill, Peripheral Pulses, U/O, ECG, Temperature
- Tachycardia
- Arrhythmias
- Hypotension
- Decreased urine output
- Pallor, Cool, clammy skin
Cardiogenic Shock: disability
- Assessment: GCS, BGL, Pain,
- Confusion, delirium progressing to unconsciousness
- Anxiety
Interventions- Reassess airway – if altered LOC
- Check BGL
- Consider hypoxia
Cardiogenic Shock: interventions
- Treat/manage the underlying cause
o Reperfusion, antiarrhythmic - Enhance pump effectiveness
o Mechanical or inotropes - Improve tissue perfusion
o Mechanical or inotropes
Distributive Shock
results from excessive vasodilation and impaired distribution of blood flow.
There are three types of distributive shock:
* Septic shock
* Anaphylactic shock
* Neurogenic shock
Septic Shock
occurs when a patient develops sepsis.
Sepsis is a life threatening condition that generally occurs because bacteria has entered the bloodstream which triggers an inflammatory response. This activates the release of inflammatory mediators.
Septic shock will develop when these inflammatory mediators cause widespread vasodilation, tachycardia, decreased myocardial contractility and decreased tissue perfusion.
Clinical manifestations of septic shock are:
- Tachypnoea
- Tachycardia
- Hot clammy skin
- Hypoxia
- Increased temperature
- Confusion
- Hypotension
- Decreased urine output
- Agitation
- Systemic oedema
