shock
failure of the circulatory system to maintain adequate perfusion of vital organs
what occurs when there is a buildup of wastes?
the body switches from aerobic to anaerobic metabolism
how do we treat shock in general?
it is cause specific
cardiovascular system parts
- pump (heart)
- set of pipes (blood vessels and arteries)
- contents (blood)
what are the types of shock and which part of the cardiovascular system do they correlate with?
pump (heart) = cardiogenic
pipes (blood vessels and arteries) = circulatory
contents (blood) = hypovolemic
what are the 3 subcategories of shock under circulatory shock?
septic, neurogenic, anaphylactic
what is the most common type of shock?
hypovolemic
what is the most common form of cardiogenic shock?
MI
what is normal MAP?
70-105 mmHG
what value of MAP must we obtain and why?
> = 65mm Hg for perfusion
how do we calculate MAP?
3
what do we assess with pulse pressure?
narrowing
what are cellular changes that occur during shock?
- anaerobic metabolism
- inc cell perm = influx of Na + H20, efflux of K+
- mitochondrial damage leading to death
what are assessments and interventions we perform when a pt is entering shock?
- apply O2 d/t dec perfusion
- check perfusion: cap refill, colour, LOC (is it altered)
- RR (is it slowing down?)
what is the first change we see with our pt if they may be entering shock?
a change in LOC - may be irritated, annoyed, agitated, sharp
what are the systemic effects of shock in relation to the cardiovascular system?
- myocardial deterioration
- DIC
- vasoconstriction
- release of lysosomal enzymes
lysosomal enzymes
- vasoactive substances
- catecholamine: epinephrine, dopamine
- histamine
- vasoactive polypeptides (bradykinin, angiotensin)
MODS
- phase of progression of shock by any cause
- altered organ fx that requires medical intervention to support continued organ fx
how does MODS progress?
usually starts in lungs, followed by cardiac instability
then progresses to hepatic, GI, renal, immunologic and CNS
mortality rate of MODS
high - one organ = 20% mortality rate, 4 or more organs = 70% mortality rate
who is at increased risk for MODS?
elderly, people with comorbidities, malnutrition, surgical or trauma wounds
hypovolemic shock
- internal or external loss of circulating volume
- blocked venous return
- organ hypoperfusion
- stages of compensation
management of hypovolemic shock
early recognition, stop and replace losses if indicated
- treat underlying cause
- blood loss, fluid shifts, dehydration, ascites or edema
- fluid and blood replacement
- fluid redistribution
- meds depending on underlying cause
crystalloids
- electrolyte solutions that move easily between intravascular and interstitial spaces
- can be given without altering [ ] of plasma e-
ie) NS, LR 3%
- 3:1 crystalloid to blood ratio
