NEUROGENI

C SHOCK
By: ERVIN VICENTE
 SHOCK
 Defined as a state of inadequate
perfusion, occurs when there is
inadequate circulation
 Tissues are deprived of oxygen
 Results in cellular metabolism
disturbance, waste accumulation 、
dysfunction
STAGES of SHOCK
stage ( Initial Phase)
 1st

- the cardiac output insufficient to

meet the metabolic needs of the body
but now low enough to produce
symptoms
STAGES of SHOCK
stage ( Compensatory Phase)
 2nd

- due to catecholamine being released

- an increase in HR. increase in CO.
Vasoconstriction
STAGES of SHOCK
stage (Progressive Stage)
 3rd

- unfavorable signs and symptoms

become more apparent:
- decrease blood pressure
- increased heart rate
- oliguria
- system dysfunction begins
STAGES of SHOCK
 4thstage (Irreversible Stage)
- myocardial depression
- massive capillary dilation
- blood remains pooled in the
extremities
- death may occur
PATHOPHYSIOLOGY
INITIAL INSULT
LEADING TO
SHOCK

DECREASE TISSSUE
PERFUSION, DECREASE
OXYGENATION

ACTIAVATION OF HEMOSTATIC
RESPONCE

INCREASE SYMPATHETIC RESPONSE, INCREASE RENIN-ANGIOTENSIN ACTIVAQTION

INCREASE SYMPATHETIC RESPONSE, INCREASE RENIN-ANGIOTENSIN ACTIVAQTION

DECREASE RR TO INCREASE SATURATION

DECREASE RR TO INCREASE SATURATION INCREASE CATECHOLAMINES AND CORTISOL
AND DELIVERY INCREASE CATECHOLAMINES AND CORTISOL
AND DELIVERY

RESTORATION OF TISSUE
PERFUSSION AND OXYGENATION
 compensatory progressive irreversible

Blood pressure normal Sys: <80 – 90 mmHg Requires mechanical

and pharmacological
support
Heart rate > 100 bpm > 150 bpm Erratic/ asystolic

Respiratory status Rapid, shallow, Requires intubations

> 20 bpm PaCO2 crakles and mechanical
<30 mm Hg ventilation and
PaCO2 > 45 mmHg
oxygenation
Urinary output decreased 0.5 mL/kg/h Anuric, requires
dialysis
Mentation confusion lethargy unconsciousness

Acid-base balance Respiratory Metabolic Profuse acidosis

Alkalosis Acidosis
 Shock

HYPOVOLEMIC CIRCULATORY CARDIOGENIC

LOSS OF
INTERNAL EXTERNAL CARDIAC
FLUID LOSS FLUID LOSS PUMPING
ACTION

SEPTIC ANAPHYLACTIC
NEUROGENIC
HYPOVOLEMIC SHOCK
SEPTIC SHOCK
CARDIOGENIC SHOCK
NEUROGENIC SHOCK
Hypovolemic Shock
 Decreased intravascular volume

 15%- 30% of volume reduction

Example:
750 -1500 ml of blood loss in 70kg patient
Pathophysiology
Dec. blood volume

Dec. venous return

Dec. stroke volume

Dec. cardiac output

Dec. tissue perfusion

Risk Factor
External (fluid losses)
 Trauma
 Surgery
 Vomiting
 Diarrhea
 Diuresis
 Diabetes insipidus
Risk Factor
External (fluid losses)
Risk Factor
Internal (fluid losses)
 Hemorrhage
 Burns
 Ascites
 Peritonitis
 Dehydration
Risk Factor
Internal (fluid losses)
Medical management
 Fluid and blood replacement
 Pharmacologic theraphy
>anti-emetic
>anti-diarrheal
>desmopressin
Nursing management
FOCUS: Primary Prevention of SHOCK
>proper positioning
>monitor V/s
>monitor I & O
>oxygenation
Cardiogenic Shock
 Inability of the heart to contract and to
pump

 Inadequate supply of oxygen to the heart

and tissue
Causes
 Coronary  Non- Coronary
 Most common  Stresses the myocardium
 Ex. Acute MI  Hypoglycemia
 Hypocalcaemia
 Tension pneumothorax
 Ineffective myocardial function
 Cardiomyopathies
 Cardiac tamponade
 Dysrhythmias
 Vulvular damage
Pathophysiology
Decreased cardiac
contraction

Decreased Stroke
Volume and CO

Decreased systemic Decreased coronary

Pulmonary congestion
Perfusion Artery perfusion
Medical management
 Coronary  Non-coronary
 PCI  Faulty cardiac valve
 CABG replacement
 Intra aortic balloon pump  Correction of
therapy dysrhytmias
 Correction of acidosis
 Treatment of tension
pneumothorax
Medical management

 Oxygenation
 Pain control
 Hemodynamic monitoring
 Fluid replacement
 Pharmacologic therapy
 Dobutamine
 Nitroglycerine
Medical management
 Pharmacologic therapy
 Dobutamine
 Nitroglycerine
 Dopamine
 Antiarhytmic
 Mechanical assistive devices
 Intra-aortic balloon counter pulsation
 VAD’s
 Total temporary artificial heart
Nursing management
 ECG monitoring
 Maintaining IABC
 Enhancing safety and comfort
 Prevent infection
 Protect the skin
 Proper positioning
 Adm. Medication for pain
Circulatory shock

 Blood volumes pools in peripheral blood

vessels
 Types:
 Septic
 Anaphylactic
 neurogenic