2. Intro:
• Shock is a critical condition brought on by the sudden drop in blood flow
through the body. Shock may result from trauma, heatstroke, blood loss, an
allergic reaction, severe infection, poisoning, severe burns or other causes.
When a person is in shock, his or her organs aren't getting enough blood or
oxygen.
3. DEF:
• Shock is defined as a state of cellular and tissue hypoxia due to either
reduced oxygen delivery, increased oxygen consumption, inadequate
oxygen utilization, or a combination of these processes.
4. Causes of shock :
• severe allergic reaction
• significant blood loss
• heart failure
• blood infections
• dehydration
• poisoning
• burns
5. TYPES:
1) Obstructive shock
• Obstructive shock occurs when blood can’t get where it needs to go. A pulmonary embolism is
one condition that may cause an interruption to blood flow. Conditions that can cause a buildup
of air or fluid in the chest cavity can also lead to obstructive shock. These include:
• pneumothorax (collapsed lung)
• hemothorax (blood collects in the space between the chest wall and lung)
• cardiac tamponade (blood or fluids fill the space between the sac that surrounds the heart and the
heart muscle)
6. 2) Cardiogenic shock
• Damage to your heart can decrease the blood flow to your body, leading to
cardiogenic shock. Common causes of cardiogenic shock include:
• damage to your heart muscle
• irregular heart rhythm
• very slow heart rhythm
7. 3)Distributive shock
• Conditions that cause blood vessels to lose their tone can cause distributive shock.
When blood vessels lose their tone, they can become so open and floppy that not
enough blood pressure supplies organs. Distributive shock can result in symptoms
including:
• flushing
• low blood pressure
• loss of consciousness
• There are a number of types of distributive shock, including the following:
• A) Anaphylactic shock-- is a complication of a severe allergic reaction known as
anaphylaxis. Anaphylaxis is usually caused by allergic reactions to food, insect
venom, medications, or latex which riggers a dangerous immune response.
8. B) Septic shock - is another form of distributive shock. Sepsis, also known as
blood poisoning, is a condition caused by infections that lead to bacteria
entering your bloodstream. Septic shock occurs when bacteria and their toxins
cause serious damage to tissues or organs in your body.
C) Neurogenic shock- is caused by damage to the central nervous system,
usually a spinal cord injury. This causes blood vessels to dilate, and the skin may
feel warm and flushed. The heart rate slows, and blood pressure drops very low.
9. 4) Hypovolemic shock
• Hypovolemic shock happens when there isn’t enough blood in your blood
vessels to carry oxygen to your organs. This can be caused by severe blood
loss, for example, from injuries.. Serious dehydration can also cause this type
of shock.
10. Stages of shock:
• Shock involves ineffective tissue perfusion and acute circulatory failure. The shock
syndrome is a pathway involving a variety of pathologic processes that may be
categorized as four stages: initial, compensatory, progressive, and refractory (Urden,
Stacy, & Lough, 2014).
• • Initial stage - cardiac output (CO) is decreased, and tissue perfusion is
threatened.
• • Compensatory - Almost immediately, the compensatory stage begins as the
body’s homeostatic mechanisms attempt to maintain CO, blood pressure, and tissue
perfusion.
11. • • Progressive - The compensatory mechanisms begin failing to meet
tissue metabolic needs, and the shock cycle is perpetuated.
• • Refractory - Shock becomes unresponsive to therapy and is
considered irreversible.
12. Types of shock in detail:
• Shock evolves through 3 phases:
• Initial non-progressive phase
• Progressive phase
• Irreversible stage
13. • Initial non-progressive phase
• Compensatory mechanism to maintain the homeostasis so that blood supply to
vital organs is maintained
• By neuro humoral mechanism which maintains blood pressure and cardiac output
• Widespread vasoconstriction of vessels except coronary and cerebral vessels
• Fluid conservation by kidney
• Tachycardia
14. • Progressive phase
• As the stage advances there is failure of compensatory mechanism, dilatation
of arterioles, veinules and capillary bed
• Because of this fluid leaks out of capillaries into interstitium and there is
sludging of blood
• This reduces the tissue perfusion leading to hypoxia
• Initially body tissue except brain and heart suffers from hypoxia
15. • Irreversible phase (decompensated stage)
• Cellular injury and tissue injury is so severe that condition does not revert back to
normal even after correcting hemodynamic defects
• Hypoxic and ischemic cell injury – causes leakage of lysosomal enzymes which
further aggravates condition
• Myocardial infarction further worsens condition
• Intestinal ischemia causes microbes from intestinal flora to enter the circulation
which produces superimposed bacteremic shock
• Acute tubular necrosis occurs in kidney
21. Treatment:
• Shock can lead to unconsciousness, breathing problems, and even cardiac
arrest:
• If you suspect that you’re experiencing shock, get medical help immediately.
• If you suspect that someone else has gone into shock, call 911 and provide
first aid treatment until professional help arrives.
22. • First aid treatment
• If you suspect someone has gone into shock, call 911. Then follow these
steps:
• If they’re unconscious, check to see if they’re still breathing and have a
heartbeat.
• If you don’t detect breathing or a heartbeat, begin CPR.
23. • If they’re breathing:
• Lay them down on their back.
• Elevate their feet at least 12 inches above the ground. This position, known as the
shock position, helps direct blood to their vital organs where it’s most needed.
• Cover them with a blanket or extra clothing to help keep them warm.
• Check their breathing and heart rate regularly for changes.
• If you suspect the person has injured their head, neck, or back, avoid moving them.
24. • Apply first aid to any visible wounds.
• If they begin to vomit, turn their head sideways. This helps prevent choking.
If you suspect they’ve injured their neck or back, avoid turning their head.
Instead, stabilize their neck and roll their entire body to the side to clear the
vomit out.
25. • Treatment, which must begin within a few minutes of attack,
• Injection of epinephrine (adrenaline), followed by the administration
of antihistamines(Avil, Levocetirizine ), corticosteroids(Prednisone),
bronchodilators(deriphylline, Aminophylline), and IV fluids and
ventilatory support . Epinephrine acts quickly, reversing anaphylactic
effects by constricting the blood vessels to increase blood pressure, by
relaxing the muscles in the lungs to improve breathing, and by stimulating
the heart.
27. • Nsg Intervention:
• Assess the client’s respiratory rate, rhythm, and depth.
• Assess client’s heart rate and blood pressure.
• Assess for any signs of changes in the level of
consciousness.
28. • Auscultate the lung for areas of decreased ventilation and the presence of
adventitious sounds.
• Assess for cyanosis or pallor by examining the skin, nail beds, and mucous
membranes.
• Monitor oxygen saturation using pulse oximetry.
• Monitor arterial blood gasses.
29. • Assist the client when coughing, and suction the client when needed.
• Place the client’s head of bed elevated. This position facilitates optimal
ventilation.
• Administer oxygen as ordered.
• Prepare the client for mechanical ventilation if oxygen therapy is ineffective.
