What is shock?
body is not getting enough oxygen. decreased perfusion or body is not able to utilize oxygen.
decreases perfusion –> anaerobic metabolism–> lactate –> metabolic acidosis —> cell death —> organ failure –> DEATH
Shock is a state of inadequate tissue perfusion that leads to impaired oxygen delivery or impaired oxygen utilization at the cellular level
Physiologically what happens
low perfusion -> anaerobic metabolism (less atp + by product of lactic acid) –> cell death and metabolic acidosis
decreased MAP= decreased baroreceptor firing (stretch receptors)
increase in RENIN –> angiotensin II and that increases thirst, and vasoconstriction and in the adrenal cortex it’ll trigger the release of aldosterone which increase in Na/Water reabsorption and increases circulating volume which hopefully will increase CO –> which will increase MAP
Posterior pituatory will detect the increase in Na from the reabsorption and secrete ADH –> increase water reabsorption
s/s of Sepsis
decreased BP
Increased HR
Weak and thready pulse
Tachypnea
End organ damage– Change in LOC, lethargy, oliguria, cold skin
Remember, sepsis is infection + organ dysfunction!
Lab values sepsis
acidosis
lactate elevated
elevated BUN/creat
elevated ALT/AST shock liver
decrease PaO2 becaue decreased perfusion
increased troponin
altered svo2
Stage 1 of shock
compensated – NO DROP IN BP
increased HR
and peripheral vasoconstriction
renin and ADH release
Ideal time to recognize to treat the underlying cause!!
Stage 2
progressive/decompensated
drop in BP
pt deteriorates
hypoxic injury - decreased perfusion/decreased o2
risk to brain (decreased CPP), heart (muscle cell death), kidney (ATN kidney failure), liver (shock liver), Lungs (increased capillary permeability, fluid build up in alveoli, ARDS –RF), vessels (DIC body uses up clotting factors)
body will slowly fall apart
Stage 3
Refractory / Irreversible
MODS - multiple organ dysfunction syndrome
there is no actual telling when you can see when they transition to this stage!
Hypovolemic shock
lack of blood volume
SVR is HIGH!
reduced volume of blood
why?
could be external blood loss by trauma or injury or internal blood loss (pancreatiis, ectopic pregnancies, GI bleeds), fluid loss (burns, emesis, diarrhea, dehydrated), ascites (decreased albumin, third spacing), excessive use of diuretics
low blood volume –> decreased preload –> decreased CO –> increased SVR to increase MAP to maintain perfusion !
signs – decreased BP
cool skin/pale
labs – lactate, cbc hgb, abg for oxygenation
treatment; stop bleeding or fluid loss
IVF, blood, FFP, albumin, support bp if not fixed with fluids
Cardiogenic Shock
pump failure –> heart is unable to meet the demand of the body
Distributive shock is separated into what subsections
neurogenic, anaphylaxis, septic
all underlying patho but all d/t increased vascular volume (volume of space the blood needs to fill)
