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What is Shock?
Inadequate perfusion of body tissue that begins at the cellular level and if left untreated results in death of tissue, organs, organ systems, and ultimately the entire organism IT IS NOT LOW BLOOD PRESSURE!
The Pump
The Heart is the pump of the cardiovascular system It receives blood from the venous system then pumps the blood to the lungs for oxygenation, then to the peripheral tissues
Stroke Volume
The amount of blood ejected by the heart in one contraction
Preload
Amount of blood delivered to the heart during diastole
Afterload
Resistance against which the ventricle must contract Determined by the degree of peripheral vascular resistance
Cardiac Output
Amount of blood pumped in one contraction Stroke volume x Heart rate=Cardiac output
Fluid
Blood is thicker and more adhesive than water Consist of plasma and formed elements: Red cells, White cells, Platelets Transports oxygen, carbon dioxide, nutrients, hormones, and metabolic waste An adequate amount is needed for perfusion
Container
Blood vessels serve as the container Under control of the autonomic nervous system they can adjust size and selectively reroute blood through microcirculation Microcirculation is comprised of the small vessels: Arterioles, Capillaries, and Venules
Container cont
Capillaries have a sphincter between the arteriole and capillary called the pre-capillary sphincter Pre-capillary sphincter responds to local tissue demands such as acidosis, hypoxia, and opens as more blood is needed
Post-Capillary Sphincter
At the end of the capillary between the capillary and venule Opens when blood is needed to be emptied into the venous system
Inadequate Pump
Inadequate preload Inadequate cardiac contractile strength Inadequate heart rate Excessive afterload
Inadequate Fluid
Hypovolemia (abnormally low circulating blood volume)
Inadequate Container
Dilated container without change in fluid volume Leak in container
Glucose breakdown. (A) Stage one, glycolysis, is anaerobic (does not require oxygen). It yields pyruvic acid, with toxic by-products such as lactic acid, and very little energy. (B) Stage two is aerobic (requires oxygen). In a process called the Krebs or citric acid cycle, pyruvic acid is degraded into carbon dioxide and water, which produces a much higher yield of energy.
Compensation Mechanisms
Catecholamines may be secreted ( I.E. Epinephrine and norepinephrine) The Renin-Angitensin system aids in maintaining blood pressure Endocrine Response by pituitary gland results in secretion of anti-diuretic hormone (ADH)
Catecholamine Release
Epinephrine and Norepinephrine release affects the cardiovascular system, causing increase in HR, increase in Cardiac contractility strength, arteriolar constriction which elevates blood pressure
Renin-Angiotensin system
Renin is released from the kidneys and acts on specialized plasma protein called Angiotensin the produces AngiotensinI. AngiotensinI is converted to AngiotensinII by enzymes in the lungs called Angiotensin Converting Enzyme (ACE)
Anti-Diuretic Hormone
Causes the kidneys to reabsorb water creating an additive to the aldostrone
Compensated Shock
Early stages of shock where the bodys compensatory mechanisms are able to maintain normal perfusion
Decompensated Shock
Advanced stage of shock that occurs when the bodys compensatory mechanisms fail to maintain normal perfusion
Irreversible Shock
Stage of shock that has progressed to the point that the body nor medical interventions correct the problem
Types of shock
Cardiogenic shock (Inadequate Pump) Hypovolemic shock (Inadequate Fluid) Neurogenic shock (Inadequate Container) Anaphylactic shock Septic shock
Cardiogenic Shock
The heart loses the ability to supply all body parts with blood Usually the result of left ventricular failure secondary to acute MI or CHF Many patients will have normal blood pressures
Hypovolemic Shock
Internal or external hemorrhage Trauma Long bone or open FXs Dehydration Plasma loss due to burns Excessive sweating Diabetic Ketoacidosis with resultant osmotic diuresis
Neurogenic Shock
Results from injury to brain or spinal cord causing interruption of nerve impulses to arteries Arteries lose tone and dilate causing hypovolemia Sympathetic nerve impulses to the adrenal glands are lost, which prevents the release of catecholamines and their compensatory effects
Anaphylatic Shock
Severe immune response to foreign substance S/S most often occur within minutes but can take up to hours to occur The faster the reaction develops the more severe it is likely to be Death will occur if not treated promptly
Septic Shock
An infection enters bloodstream and is carried throughout body Toxins released overcome compensatory mechanisms Can cause dysfunction of one organ system or cause multiple organ dysfunction
TX of Septic Shock
Airway control Administer oxygen IV of crystalloid solution Dopamine for blood pressure support Monitor other vitals
Progression To MODS
Infection Sepsis Septic shock MODS Death(if not corrected early)
Primary MODS
Organ damage due to specific cause such as ischemia or inadequate tissue perfusion from shock, trauma, or major surgery Stress and inflammatory responses may be mild or undetected During the response, neutrophils, macrophages, and mast cells are thought to be primed by cytokines
Secondary MODS
The next time there is injury, ischemia, or infection the primed cells are activated, producing and exaggerated inflammatory response The inflammatory response enters a selfperpetuating cycle causing damage and vasodilation And exaggerated neuroendocrine response is triggered causing futher damage
Within 24 to 72 hours
Pulmonary failure begins
Within 7 to 10 days
Hepatic failure begins Intestinal failure begins Renal failure begins
Within 14 to 21 days
Renal and Hepatic failure intensify Gastrointestinal collapse Immune system collapse
After 21 days
Hematologic failure begins Myocardial failure begins Altered Mental status resulting from Encephalopathy Death