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Shock
Complex clinical syndrome that may
occur at any time and in any place
It is a life-threatening condition often
requiring team action by many
healthcare providers
Defined as a failure of the circulatory
system to maintain adequate
perfusion of vital organs
Major classifications
Hypovolemic shock due to
inadequate circulating blood volume
resulting from hemorrhage with
actual blood loss, burns with loss of
plasma proteins and fluid shifts, or
dehydration with a loss of fluid
volume
Major classifications
Cardiogenic shock due to
inadequate pumping action of the
heart because of primary cardiac
muscle dysfunction or mechanical
obstruction of blood flow caused by
MI, valvular insufficiency due to
disease or trauma, cardiac
dysrhythmias, or an obstructive
condition, such as pericardial
tamponade, or pulmonary embolus
Major classifications
Distributive shock due to changes in
blood vessel tone that increase the size
of the vascular space without in increase
in the circulating blood volume
Further divided into:
Anaphylactic shock severe hypersensitivity
reaction resulting in massive vasodilation
Neurogenic shock interference with nervous
system control of the blood vessels (SCI)
Septic shock due to release of vasoactive
substances
Hypovolemic shock
Hemorrhage
Blood volume deficit of 15% to 25%, or about
500 to 1,500 ml in an adult with a normal
circulating volume
Burns
Occurs with large partial-thickness or fullthickness burns
May also have cardiac dysfunction due to MDF
Dehydration
Occurs from either reduced oral fluid intake or
significant losses of fluid
Cardiogenic shock
Myocardial infarction
Impaired myocardial contractility may also occur
with blunt cardiac trauma, cardiomyopathy, and
CHF
Obstructive conditions
Large pulmonary embolism, pericardial
tamponade, and tension pneumothorax
Other causes
Cardiac valvular deficiency, myocardial
aneurysms, rupture of valvular papillary muscle,
rupture of a ventricle, aortic stenosis, mitral
regurgitation, and cardiac dysrhythmias
Distributive shock
Acute Allergic Reaction (anaphylactic
shock)
Penicillin, penicillin derivatives, bee
stings, chocolate, strawberries, peanuts,
snake venom, iodine-based contrast for
x-rays, foods and NSAIDs
Pathophysiology
Interrelated components of the
cardiovascular system:
Heart
Vascular tone
Blood volume
Pathophysiology
RAAS
MAP should be 70-105 mmHg
MAP = (systolic + [2 x diastolic[) / 3
Stages of shock
Early Compensation stage
Decompensation stage
Progressive stage
Cardiovascular system
Myocardial deterioration
DIC
Vasoconstriction
Neuroendocrine system
Adrenal response
Pituitary response
Metabolic response
Neurologic response
Tachypnea
Tachycardia
Hypotension
Changes in LOC
Oliguria
Medical Management
Maintaining adequate perfusion
Vasoconstrictors
Vasodilators
Improving oxygenation
Assisting circulation
MAST Garment
Intra-aortic balloon pump
Modified Trendelenburgs position
Medical Management
Replacing fluid volume
Crystalloid or Balance Salt Solution
Colloid solutions
Blood
Providing autotransfusion
Evaluating Fluid replacement
Providing pharmacologic Management
Monitoring Urine Output
Preventing GI bleeding
Nursing Management
Assessment
Non invasive techniques (ABC)
Blood Pressure monitoring
Invasive techniques (CVP)
Diagnosis
Evaluation
Thank you!