Shock

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

Etiology and Risk Factors

Insufficient quantity of blood
(hypovolemic)
Incompetent pump (cardiogenic
shock)
Ineffective delivery of blood
(distributive shock)

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

Spinal Cord Injury (Neurogenic shock)

Infection (Septic shock)

Pathophysiology
Interrelated components of the
cardiovascular system:
Heart
Vascular tone
Blood volume

Heart and brain are the organs

considered vital to survival. GIT, skin,
muscle, and kidneys are not considered
by the body as vital to survival

Pathophysiology
RAAS
MAP should be 70-105 mmHg
MAP = (systolic + [2 x diastolic[) / 3

Stages of shock
Early Compensation stage
Decompensation stage
Progressive stage

Systemic affects of shock

Respiratory system
Acid-Base balance

Cardiovascular system
Myocardial deterioration
DIC
Vasoconstriction

Neuroendocrine system
Adrenal response
Pituitary response
Metabolic response
Neurologic response

Systemic affects of shock

Effects on Immune system
Effects on GI system
Effects on Renal system

General Clinical Manifestations of

Shock

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!