Shock explain superficial Medical concept for nursing officers

1. SHOCK
CIRCULATORY SHOCK

2. INTRODUCTION
• SHOCK IS A DECREASE BLOOD SUPPLY TO THE
TISSUE AND ORGANS OF THE BODY.
• IT IS A WHOLE BODY CIRCULATORY FAILURE.
• BODY TISSUES IS NOT GETTING ENOUGH BLOOD
FROM CIRCULATION.
• BLOOD FLOW TO THE TISSUE IS DANGEROUSLY
LOW AND ITS LEADS TO CELLULAR DAMAGE AND
FAILURE OF MULTIPLE ORGAN FAILURE.

3. DEFINITION
• SHOCK MAY BE DEFINED AS INADEQUATE DELIVERY OF
OXYGEN AND NUTRIENTS TO MAINTAIN NORMAL TISSUE
AND CELLULAR FUNCTIONS.
- SCHWARTZ’S
• IT IS A CLINICO-PATHOLOGICAL CONDITION IN WHICH
CARDIOVASCULAR SYSTEM COLLAPSED RESULTED IN
INADEQUATE TISSUE PERFUSION AND GENERALIZED
HYPOXIA TO THE MULTIPLE SYSTEMS OF THE BODY.

4. OBJECTIVES
• BASIC INTRODUCTION OF SHOCK
• DEFINITION OF SHOCK
• TO KNOW ABOUT STAGES OF SHOCK
• REVIEW ABOUT CLASSIFICATION OF SHOCK
• TO ELABORATE ABOUT ETIOLOGY AND CLINICAL
FEATURES
• MANAGEMENT ASPECT ABOUT SHOCK

5. ETIOLOGY
 BLOOD LOSS  CARDIAC
TEMPONADE
PLASMA LOSS  PULMONARY
EMBOLISM
 ELECTROLYTES IMBALANCE  TENSION
PNEUMOTHORAX
 VALVULAR DYSFUNCTION  AIR EMBOLISM
 MI  SPINAL ANAESTHESIA
 ARRHYTHMIAS  TRAUMA TO SPINAL

6. CLASSIFICATION
1.HYPOVOLEMIC SHOCK
2.CARDIOGENIC SHOCK
3.OBSTRUCTIVE SHOCK
4.DISTRIBUTIVE SHOCK
I. ANAPHYLATIC SHOCK
II. NEUROGENIC SHOCK
III. SEPTIC SHOCK

9. STAGES OF SHOCK
• 1. INITIATION STAGE :- CELLS BECOME LEAKY AND
SWITCH TO ANAEROBIC METABOLISM.
• 2. COMPENSATED STAGE :- ATTEMPT TO CORRECT
METABOLIC UPSET OF SHOCK VIA SNS REGULATION AND
RAAS.
• 3. DECOMPENSATED STAGE :- COMPENSATORY
MECHANISM WILL BE FAILED AND SHOCK IS IN MORE
PROGRESSIVE STAGE.
• 4. REFRACTORY STAGE :- ORGANS FAIL AND SHOCK CAN
NO LONGER BE REVERSED.

10. EFFECT ON ORGANS
• HEART :- TACHYCARDIA, DECREASE CO, HYPOTENSION.
• LUNGS :- TACHYPNEA, DECREASE GAS EXCHANGE,
PULMONARY EDEMA.
• ENDOCRINE :- INCREASE ADH, INCREASE SODIUM AND
WATER REABSORPTION.
• CNS :- DECREASE PERFUSION PRESSURE,
DROWSINESS.
• BLOOD :- COAGULATION ABNORMALITIES.
• RENAL :- DECREASE GFR, DECREASE UO.

11. CLINICAL FEATURES
• TACHYCARDIA (RAPID, WEAK, THREADY PULSE)
• BRADYCARDIA IN NEUROGENIC SHOCK
• TACHYPNEA (RAPID, SHALLOW RESPIRATION)
• HYPOTENSION
• COOL AND CALMY SKIN (WARM SKIN IN NEUROGENIC
SHOCK)
• OLIGURIA (< 30ML/HOURS)
• ANURIA

12. CONTINUED...
• DIZZINESS OR FAINTING
• CONFUSED AND DROWSINESS
• NAUSEA, VOMITING, DIARRHOEA
• THIRST, DRY MOUTH
• UNCONSCIOUSNESS
• MULTI ORGAN FAILURE

13. DIAGNOSTIC EVALUATION
• HISTORY COLLECTION
• PHYSICAL EXAMINATION
• BP MEASUREMENTS
• ECG
• ECHO
• X-RAY
• BLOOD TESTS LIKE ABG ANALYSIS, RFT, LFT, CBC, ESR,
TROP-I.
• ANGIOGRAPHY

14. MANAGEMENT OF SHOCK
• PHARMACOLOGICAL MANAGEMENT
• INOTROPES – DOBUTAMINE, DOPAMINE,
ADRENALINE.
• VASOPRESSOR – PHENYLEPHRINE, NE.
• FLUID REPLACEMENT – COLLOIDS AND
CRYSTALLOIDS.
• ANTICOAGULANT – HEPARIN.
• VASODILATOR – NTG.

15. CONTINUED...
• DIURETICS – FRUSEMIDE OR FUROSEMIDE.
• VASOCONSTRICTION – NE.
• ANTIHISTAMINE – CHLORPHENIRAMINE,
CETRIZINE.
• ANTIBIOTICS
• SPECIFIC GAMMA GLOBULIN
• CORTICOSTEROIDS

16. NURSING MANAGEMENT
• CAB – CIRCULATION, AIRWAY, BREATHING
• ASSESSMENT OF TISSUE PERFUSION
• VITAL SIGNS MONITORING
• PERIPHERAL PULSE
• LEVEL OF CONSCIOUSNESS
• CALILLARY REFILL
• ALLERGIES
• ONSET AND DURATION OF SYMPTOMS

17. CONTINUED...
• RESPONSE OF PATIENT GIVE CPR IF NEEDED
• LAY TCHECK HE PERSON FLAT AND FACE-UP
• DO NOMOVE PATIENT IF CEREBRAL AND SPINAL INJURY
IS SUSPECTED
• RAISE PERSON FEET ABOUT 12 INCHES
• CHECK SIGN OF CIRCULATION
• KEEP THE PERSON WT ARM AND COMFORTABLE
• NBM, IF PERSON WANTS WATER JUST MOISTEN LIPS
• IDENTIFY CAUSE AND TREAT ACCORDINGLY

18. THANK YOU🙏