The document discusses shock and its stages, defining it as a physiologic state characterized by reduced tissue perfusion due to issues like blood loss or decreased cardiac contractility. It covers the stages of shock and types like hypovolemic, cardiogenic, and distributive shock, explaining their pathophysiology, assessment, and management with a focus on hypovolemic and cardiogenic shock.

1. PALWASHA KHAN
BSN (COLLEGE OF NURSING NMU)
Shock and Critical care

2. Definition:
Shock is a physiologic state characterized by systemic
reduction in tissue perfusion, due to excessive blood
loss or decrease cardiac contractility resulting in
decrease tissue oxygen delivery.
What is shock

3. Stage 1:
 In this stage body activates compensatory mechanism in
an attempt to maintain circulatory volume, blood
pressure, and cardiac output.
 In this initial non-progressive stage, compensatory
mechanisms are effective .In maintaining relatively
normal vital signs and cerebral perfusion and the shock
state often goes unrecognized.
 If the cause of shock is successfully treated at this time,
the patient may make a full recovery.
Stages of shock

4. Compensatory Mechanism of Shock

5. Stage 2:
 In this intermediate progressive phase, compensatory mechanisms begin to fail,
metabolic and circulatory derangements becomes more pronounced and the
inflammatory and immune responses become fully activated.
 Interventions that target both the causes of the shock and the resulting metabolic,
circulatory, and inflammatory responses are necessary to save the patient’s life.

6. Stage 3:
 In the final irreversible stage, the cellular and tissue
injury are so sever that the patient's life is not sustainable
even if metabolic, circulatory and inflammatory
derangements are corrected.
 At this time full blown multisystem organ dysfunction
syndrome may become evident.
 The goal is reestablish adequate organ perfusion, and
to lessen the inflammatory response as quickly as possible.

7. Stage 3:
 Early recognition of shock and ongoing assessment to evaluate the effectiveness of the
intervention in shock state is key.
 Assessment such as gastric PH, tidal carbon dioxide (ETCO2) and
central venous oxygen saturation measurements may facilitate earlier recognition of
hypo-perfusion.

8. Types of Shock
Shock can be classified as:
1) Hypovolemic Shock
2) Cardiogenic Shock
3) Distributive Shock.

9. Hypovolemic Shock:
Definition:
Hypovolemic shock refers to the inadequate volume of blood, which may be caused
by sudden blood loss, sever dehydration or injuries that causes significant fluid shift
from intravascular space to the interstitial space (e.g. burns)

11. Hypovolemic Shock Pathophysiology:

12. Hypovolemic Shock Pathophysiology:

13. Hypovolemic Shock:
Assessment:
 A thorough history may reveal underlying causes of Hypovolemic shock (e.g. Use
of NSAIDs).Clinical findings are related to the severity and acuity of volume loss.
 Assessment of serum lactate, arterial pH, and acid base deficit helps to determine
the presence of acidosis metabolism and facilities monitoring the fluid
replacement.
 Serial Hemoglobin and hematocrit panels are used to assess the need blood
product replacement. However, for several reasons the hemoglobin and hematocrit
may not directly reflect the severity of blood loss.

14. Hypovolemic Shock:
Management:
 Management of Hypovolemic shock focuses on resolving the cause of volume loss
and restoring circulating volume through volume administration.
 Ideally. A large-bore (16-guage or larger) IV catheter is used for the rapid infusion
of fluids. Fluids are warmed during infusion to limit the negative effects of
hypothermia.
 Isotonic crystalloid solution (e.g. lactate Ringer’s solution , 0.9% normal saline) are
used as first line therapy.
 Blood products and other colloid solutions (albumin and synthetic volume
expanders) may be used to assist in resuscitation process, especially if blood loss is of
primary cause.

15. Cardiogenic Shock:
Definition:
 Cardiogenic shock refers to the loss of contractility
of the heart, an extreme form of heart failure, most
commonly caused by extensive left ventricular
damage from myocardial infarction.
 Other causes include papillary muscle rupture,
ventricular septal rupture, cardiomyopathy, acut
myocarditis, valvular disease, and dysrrhythmias.

17. Cardiogenic Shock pathophysiology:

18. Cardiogenic Shock:
Assessment:
Cardiogenic shock commonly develops within few hours after the onset of myocardial
infarction symptoms; therefore patients require close monitoring.
Management:
The goals of patient management for Cardiogenic shock are:
1. Optimize cardiac output
2. Decrease left ventricular workload

19. Cardiogenic Shock:
Optimizing Cardiac Output:
 Careful monitoring and interpretations of hemodynamic parameters is necessary to
achieve the goals of optimizing cardiac output.
 Optimal filling pressures assist in restoring cardiac output but must be attained cautiously.
 In general, a pre-load (Left ventricular end-diastolic pressure LVEDP of 14 to 18 mmHg
should be maintained.Pharmacologic agents can be used to augment cardiac output

20. Cardiogenic Shock:

21. Cardiogenic Shock
Decreasing left ventricular workload:
 Pharmacotherapy: Vasodilators may be administered to reduce SVR and LVEDP.
Narcotic analgesics may also be used to decrease myocardial oxygen demand.
 Mechanical support devices: Such as an intra0aortic balloon pump (IABP) or left
ventricular assist device, supplement the heart’s ability to pump, reducing the workload.
 Mechanical Ventilation: May be necessary to increase oxygen saturation, improving
oxygen delivery to the tissues.
 Scheduling physical care: to ensure periods of rest also helps to minimize myocardial
energy expenditure