what is shock?
decreased blood flow causes DECREASED TISSUE PERFUSION»_space;> causes cellular hypoxia
initial stage of shock:
- cells switch from aerobic to ANAEROBIC metabolism b/c of hypoxia
- CO is decreased
- metabolism byproduct is lactic acid
- –liver normally converts lactic acid to glucose, but liver is NOT being perfused»_space; so lactic acid builds up in blood and CAUSES LACTIC ACIDOSIS
hypovolemic shock
> 15% decr. in blood volume
causes:
-hemorrhage, dehydration, burn, diarrhea, vomiting, DI, third spacing)
–losing blood = decr CO
tx:
-blood transfusion
(GOAL HCT= 30-50% // GOAL HBG = 12-15)
**watch for HYPOCALCEMIA (citrate binds Ca)
-IV fluids crystalloids (watch for fluid shifts)
& volume expanders»_space; colloids (watch for decr coagg.)
- NPO (until GI func. returns)
- O2 / may need vent (decr. O2 carrying capacity)
- ABG, H/H, electrolytes, BUN/Creat
- support vital function (vasopressors)
meds: sodium bicarb (bind LA); antidysrhytmics; digoxin
cardiogenic shock = pump failure
p. 1225
MI is #1 cause
s/s directly r/t R & L sided HF
**profound cyanosis*
tx:
* *caution IVF (double concentration of the drip)
- -same tx as hypovolemic shock
distributive shock
widespread vasodilation
BLOOD VOLUME DOES NOT CHANGE (its all in your feet)
blood pools OUT/AWAY from core
s/s:
- -peripheral edema
- -tachycardia/tachypnea
- -decr UO
- -hypotension
- -longer cap refill
3 types ( neuro, anaphyl., septic)
distributive shock: septic
most common type of shock
inflammatory
EARLY: warm phase
- increased pulse and warm flushed skin
- feel hot but be cold (chills)
LATE: cold phase
-hypotension, tachy, arryth, cool/pale, edema, lethargy/coma, oliguria/anuria
BOTH have decr. CVP
tx:
- ASSESS for DIC»_space; mini clots (watch IV sites; tx w/ heparin)»_space;D-DIMER DRAW (non-specific for any clot type)
- broad spectrum abx & IVF
- VS, O2, monitor labs, blood cultures
- DOBUTAMINE (incr CO & HR)
distributive shock: neurogenic
(spinal shock = nervous system failing; not r/t volume)
NEUROGENIC SHOCK HAS TO DO W/ THE DISTRIBUTION OF BLOOD THROUGHOUT THE BODY (volume)
VS.
spinal shock = disconnect in signalling
loss of reflexes below LOI
SNS fails; imbal b/t SNS & PNS
“fight or flight fails” = DILATION/POOLING into periphery
- ** 1st thing seen is BRADYCARDIA ***
- hypotension
- slow/bounding pulse
- skin warm & dry
- anxious/restless/lethargic/comatose
- oli/anuirc
- lower body temp
causes:
cord injuries or head trauma
tx:
- REDUCE PNS stimulation (stimulate them: cold, loud)
- CORTICOSTEROIDS (help injury)
- vasoactive med (dopamine, dobutamine)»_space;incr BP
- monitor labs; give O2
distributive shock: anaphylactic
widespread sensitivity rxn
s/s:
- hypotension
- incr HR, dysrhythmias
- RESP: dyspnea, stridor, wheeze, laryngospasm, bronchospasm, pulmonary edema
- skin is warm & EDEMATOUS
- restless, anxious, lethargic/comatose
- oli/anuric
- parasthesias, pruritus, abd. cramps, vomiting, diarrhea
tx:
- treat underlying cause
- CORTICOSTEROIDS (stop inflammation)
- ALBUTEROL
- REMOVE ALLERGEN
- monitor & support vital functions
* **AIRWAY is 1st to go in anaphylactic shock»_space;>
- artificial airway if needed
- O2 / may need ventilator
- labs (EOSINOPHILS HIGH b/c they indicate inflammation)
shock diagnostic tests
- WBCs
- -total WBC : sepsis
- -eosinophils : anaphylaxis
- -neutrophils/monocytes: acute bacterial infection
- H/H
- electrolytes
- BUN/creatinine
- blood cultures
- cardiac enzymes
- CVCs
- ***serum lactate (look at metabolic status)»_space;acidosis
