Lecture 7 Shock

Definition of Shock It is a condition in which systemic blood pressure is inadequate to provide perfusion to the vital organs. 2

1. Hypovolemic: inadequate blood volume 2. Cardiogenic: failure of the heart as a pump 3. Neurogenic: neural alterations of vascular smooth muscle tone 4. Anaphylactic: immunologic processes or allergic reactions 5. Septic: systemic inflammatory response to microorganisms and/or damaged 3

Hypovolemic Caused 1. loss of whole blood (hemorrhage), 2. plasma (burns) 3. diaphoresis, 4. DM/hyperglycemia, 5. DI, 6. emesis 7. diuresis 4

 LOC  Skin: cool, moist, pale skin  Resp rate: rate and depth are increased and pt c/o dyspnea  Heart rate: pulse is weak and thready,  Blood pressure: decreases  Urine output: decreased ( oligurea ) 5

Note 1. Hypovolmic shock is most common type of shock 2. problem associated with hypovolmic shock is Altered tissue perfusion Impaired gases exchange Decrease cardiac out put ( dec.Bp) 6

Treatment of Hypovolemia  Early detection and minimizing the loss are key  Restoration of fluids and plasma volume 7

Causes of Cardiogenic Shock 1. MI (>40% of muscle loss) 2. Valve dysfunction 3. Severe dysrhythmias 4. Pulmonary embolism 8

Treatment of Cardiogenic Shock 1. Increase oxygen supply to the heart 2. Decrease heart work Goal of treatment 1. Restore and maintain tissue perfusion 2. Correct physiologic abnormality 9

Neurogenic Shock  Also called vasogenic shock  Causes: Develops with spinal anesthesia, spinal cord injury, altered function of the vasomotor center in response to  low blood sugar  drugs, including sedatives, barbiturates, and narcotics 10

Anaphylactic Shock 11 1.Result of a severe allergic or antigen- antibody reaction 2.Reaction causes a release of histamine, causing vasodilation 3.bronchoconstriction

Causes of Anaphylactic Shock 1. Substances that act as antigens: 1. Drugs (ex: PCN) 2. Contrast media 3. Transfused blood 4. Insect venoms 5. Foods (ex: shellfish) 6. Pollens 7. Latex allergies 2. Once in the body, the antigen causes an extensive immune and inflammatory response causing vasodilation 12

Symptoms of Anaphylactic Shock Onset of symptoms is within seconds and progression can lead to death in minutes Allergic reaction sx:  Edema  Uticaria (hives)  Burning, itching skin  Difficulty breathing  Anxiety  Enlarged tongue 13

First Aid  Check the person's airway, breathing, and circulation. If necessary, begin rescue breathing and CPR.  Even if the person is able to breathe on his or her own, continue to check rate of breathing at least every 5 minutes until help arrives.  If the person is conscious and DOES NOT have an injury to the head, leg, neck, or spine, place the person in the shock position. 14

4. Lay the person on the back and elevate the legs about 12 inches. 5. DO NOT elevate the head. If raising the legs will cause pain or potential harm, leave the person lying flat. 6. Give appropriate first aid for any wounds, injuries, or illnesses. 7. Keep the person warm and comfortable. Loosen tight clothing 15

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1. Turn the head to one side so he or she will not choke. Do this as long as there is NO suspicion of spinal injury. 2. If a spinal injury is suspected, "log roll" him or her instead. Keep the person's head, neck and back in line and roll him or her as a unit. 17