Common Causes of Shock
- Trauma
- Hypovolemia
- Severe hemorrhage
- Widespread infection (sepsis)
Result of Shock
Results in the collapse of the cardiovascular system
* lack of tissue perfusion from poor circulation
* venous pooling and tissue acidosis
Shock
Clinical Signs
- Pale or gray mm color
- Prolonged / increased CRT due to decreased perfusion
- Elevated HR; up to 200 bpm
- Weak pulse
- Cold extremities; may be normal shortly after trauma
- Depressed attitude
- Increased breathing
Shock Treatment
- IV Fluids
- Colloids
- Corticosteroids
- Glucose
- Sodium Bicarbonate
- Oxygen
IV Fluids for Shock
Use fluids that contain electrolytes
* crystalloids
* LRS
* saline
* normosol
Adminster at a rapid rate
Colloids
Fluids that contain larger molecules retained in the intravascular space longer than crystalloids
* blood products like whole blood and plasma
* hetastarch
Give one bolus and reassess
* do not repeat if no response
Advantages of Corticosteroids
- Stabilization of cell membranes
- Improves cardiovascular performance
Corticosteroid Forms
- Dexamethasone
- Prednisolone
- Water-soluble forms more appropriate - given IV and rapid effect
Glucose
Useful in septic shock
* patient is usually hypoglycemic
* blood glucose high in early stage
Sodium Bicarbonate
- Used to counteract acidosis
- May interfere with function of some drugs
Sepsis
Definition
Inflammatory response to infection with bacteria, viral, protozoa, or fungal organisms
Septic Shock
Definition
Sepsis with hypotension despite fluid resuscitation
Early Signs of Septic Shock
Body will be trying hard to respond to infection
* increased temp
* increased HR
* dark pink/red mm
* perfusion less than 1 second
Septic Shock Diagnostic Tests
- PCV / TP
- WBC count
- Blood glucose
check every 4-6 hours
Septic Shock Treatment
Crystalloids AND Colloids
Types of Shock
- Hypovolemic
- Cardiogenic
- Distributive
- Obstructive
difference is where they start
Distributive Shock
Types
- Traumatic
- Anaphylactic
- Neurogenic
- Septic
Hypovolemia Causes
- Blood loss
- Vomitting / Diarrhea
Hypovolemia
Oxygen Delivery
- Decreased
- Cells metabolize energy anaerobically
- Produces lactate
Hypovolemia
Decreased Blood Volume
Heart has less blood to pump
* works harder
* increases HR
Decreased blood pressure
* vessels constrict to try to improve BP
* less blood going to organs
Cycle of Shock
- Reduced blood volume
- Decreased blood return to heart
- Decreased cardiac output
- Decreased BP due to low volume
- Decreased blood flow to tissues (vasoconstriction)
- Eventual tissue hypoxia - cell and organ death
Obstructive Shock
Decreased blood return to the heart
Shock Dose
- Equivalent to blood volume
- Given over an hour
Hypertonic Solution
Bolus has potential to pull fluid from elsewhere
* not good for dehydration
