SHOCK

28/11/2014CRITICAL CARE
1
DEPARTMENT OF NURSING
DONE BY: RN, BSc.N ABDULLA K NGWALI
SECOND YEAR,
SEMISTER ; 1
LECTURE; RAHMA JARUFE

TOPIC
28/ 11/ 2014CRITICAL CARE2

TOPIC: CARDIOVASCULAR
SYSTEM
SUB TOPIC: SHOCK
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Learning objectives’-
 At theend of thissession every leaner should
beableto understand thefollowing:-
 Define shock
 List thestageof shock
 Describetypesof shock with its causes, sign
 and symptoms.
 Explain thepath physiology of shock
 List sign & symptomsof theshock in general.
 Mention thecomplication of shock.
 DescribeManagement & treatment of shock

Definition
 Shock isaseriousmedical condition where
thetissueperfusion isinsufficient to meet
demand for oxygen and nutrition becausethe
body isnot getting enough blood flow.
Shock often accompaniessevereinjury /
illness.
OR
 Isalifethreatening condition that occurs
when thebody isnot getting enough blood
flow.
Zanzibar university

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OR
 Isasudden fall in theblood passing through the
tissuesof thevital organ.

STAGE OF SHOCK
 Thefollowing stageincreaseyour chancesof
developing shock:
(a) “PRE- SHOCK”
(b) SHOCK
(c) “END ORGAN DYSFUNCTION”

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28/ 11/ 2014CRICAL CARE8
(a) “PRE- SHOCK”
Body isableto compensatefor decrease
perfusion up to 10% reduction n blood volume.

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(b) “SHOCK”
Compensatory mechanism overwhelmed see
signs(symptomsof organ dysfunction) 20-25%
reduction in blood volume.
(c) “ENDORGAN DYSFUNCTION”
Learning to irreversibleorgan damageor death.

Types of shock
 Shock can bedivided into:
A. Hypovolemic shock
B. Cardiogenic shock
C. Obstructive shock
D. Distributiveshock
They are;-
( !) Sepsis
(2) Neurogenic (spinal shock)
(3) Anaphylaxis
(4) Electricity

(A). Hypovolemic shock
 Hypovolemic shock (caused by inadequate
blood volume)
Hypovolemic shock isan emergency condition in
which severeblood and fluid lossmakestheheart
unableto pump enough blood to thebody.
Thistypeof shock can causemany organsto stop
working.

 Itsprimary causeishemorrhagedueto trauma
(internal and/or external), or lossof fluid from the
circulation and vomiting and diarrhea arethe
most common causein children.
With other causesincluding burns.
Cause of hypovolemic shock

SIGN AND SYMPTOMS
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 A rapid, weak, thread pulsedueto decreased
blood flow combined with tachycardia.
 Cool, clammy skin due to stimulation of
vasoconstriction.
 Rapid and shallow breathing dueto sympathetic
nervoussystem stimulation and acidosis

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Hypothermia dueto decreased perfusion and
evaporation of sweat.
Thirst and dry mouth, dueto fluid depletion.

{B} Cardiogenic shock
Cardiogenic shock isadiseasestatewherethe
heart isdamaged enough that it isunableto
supply sufficient blood to thebody.

Sign and symptoms
 Distended jugular veins dueto increased
 jugular venouspressure.
 Weak or absent pulse.
 Arrhythmia often
 Tachycardia.

CAUSES OF CARDIOGENIC SHOCK
 Cardiogenic shock iscaused by thefailureof the
heart to pump effectively.
 Thiscan bedueto damageto theheart muscle,
most often from alargemyocardial infarction.
 Cardiomyopathy /myocarditis
 Congestiveheart failure(CHF)
 Cardiac valve problems.

OBSTUCTIVE SHOCK
 Isdueto obstruction of blood flow outsideof
theheart.
Several conditionscan result in thisform of
shock.

Causes of obstructive shock
 Cardiac tamponade in which fluid in thepericardium
preventsinflow of blood into theheart (venousreturn).
Constrictivepericarditis in which thepericardium shrinks
and hardens, issimilar in presentation.
 Tension pneumothorax Through increased intrathoracic
pressure, blood flow to theheart isprevented (venous
return).

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 Pulmonary embolism istheresult of a
thromboembolic incident in theblood vesselsof
thelungs and hindersthereturn of blood to the
heart.
 Aortic stenosishinderscirculation by
obstructing theventricular outflow tract.

Sign and symptoms of
obstructive
Low blood pressure
Lack of oxygen to body tissue
Clammy skin
Cool skin.

{C} DISTRIBUTIVE SHOCK
Isdueto impaired utilization of oxygen and thus
production of energy by thecell.
Distributiveshock includethefollowing;-
 Septic
 Anaphylactic,
 Neurogenic,
 Electricity

Causes of distributive shock
 It can becaused by;-
 Systematic Inflammatory ResponseSyndrome
(SIRS)
 Dueto conditionsother than infection such as
pancreatitis,burns, or trauma.

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 Toxic Shock Syndrome(TSS)
 Anaphylaxis(A sudden ,severeallergic reaction)
 Reactionsto drug or toxins.
 Hepatic (Liver) insufficiency and damageto the(
CNS)

Sign and symptoms of
distributive
Temperature<36 OR > 38
Heart rate>90 beatsper minutes
Respiratory Rate>20bmin

{a} SEPTIC SHOCK
 Septic shock ( associated with infections)
Septic shock isaseriouscondition that occurs
when an overwhelming infection leadsto low
blood pressureand low blood flow.
Thebrain, heart, kidneys, and liver may not work
properly or may fail.

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CAUSES OF SEPTIC
 Septic shock can becaused by ;-
1) Gram negative
 Bacteriasuch as(among others) Escherichia
co li, Proteusspecies, klebsiela, pneumo niae which
releasean endotoxin which produces adverse
biochemical,
 Immunological and occasionally neurological
effects which are harmful to the body.

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2) Gram-positive
 Cocci such aspneumococci and
 Streptococci and certain fungi aswell asGram-
positive
bacterial toxins.
 Septic shock also includessomeelements of
cardiogenic shock.

Symptoms of septic
shock
 Symptomsare:
similar to hypovolaemic shock except in thefirst
stages:
Pyrexiaand fever, or hyperthermia, dueto
overwhelming bacterial infection.
 Vasodilation and increased cardiac output due
to sepsis.

(b) Anaphylactic shock
 Is a type of severe hypersensitivity or allergic
reaction.

causes
 Causesinclude;-
 Allergy to insect stings, medicines, or foods
(nuts, and seafood), etc.

Sign and symptoms of anaphylactic
 Polyuria,
 Respiratory distress, hypotension (low blood
pressure),
 Encephalitis, fainting, unconsciousness,
 Urticaria(hives),
 Angioedema(swelling of thelips, face, neck
and throat), Tears(dueto angioedemaand stress),
 Vomiting, itching,
 Anxiety,
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(d) Electrical Shock
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 Isthephysiological reaction or injury caused by
electric
current passing through thehuman body.
OR
 An electric current that passesthrough thebody is
also called ashock.
 And it can beso dangerous but electrical
shock isdifferent from themedical shock
discussed .

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In electric shock Oxygen isroutinely given, to the
victim and somepeopleneed to beput on a
ventilator (abreathing machine) to increasethe
amount of oxygen getting to their cells.

Causes
Electrical causecan causeinjuriesincluding
burnsand disturbancesto heart rhythm
(heart failure) that could befatal.
01/09/15critical care39

Sign and symptoms
 Unconsciousness.
 Burns, particulary entranceand exit burns(
wheretheelectricity entered and left thebody.)
 Difficult in beathing or n breathing at all.
 Sudden onset of cardiac arrest.

PATHOPHYSIOLOGY OF SHOCK
Cellsswitch from aerobic to anaerobic metabolism
Lactic acid production
Cell function ceasesand swells
Membranebecomesmorepermeable
Electrolytesand fluidsseepsin &out of cell.

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Na and K pump impaired
Mitochondria damage cells death

Sign and symptoms in general types
 ) Rapid respiration
2) Cold and clammy skin,
3) A weak but rapid pulse,
4) Fall in blood pressure, dueto reduction of blood
volume
 5) Weaknessall over thebody.
6) Dizzy, confused, and may becomeunconscious.
Intensivethirsty dueto lossof water
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GENERAL COMPLICATION OF SHOCK
 Kidney disease
 Liver disease
 Intestinal ischemia
 Stroke
 Disseminated intravascular coagulation (DIC)

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 Respiratory failure
 Heart failure
 Death

Managements and Treatments
shock
 Airway
 breathing
 Circulation
 Treatmentsof shock alwaysshould beaimed to
correct thecauseof shock and helping
physiological compensatory mechanism to restore
thetissueperfusion.

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 Themain goalsof thetreatment of cardiogenic
shock arethere-establishment of circulation to the
myocardium, minimising heart muscledamageand
improving theheart’seffectivenessasapump.
 Oxygen (O2) therapy to reducestheworkload
of theheart by reducing tissuedemandsfor blood
flow.
 Administration of cardiac drugs

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 Increaseheart’spumping action and decrease
work load of theheart through medication such as
Dopamine, dobutamine, epinephrine,
norepinephrine.
 Nitroglycerineuseful only if cardiogenic shock
accompanied by appropriate
 Dosage10mg-min 6ml-hr increaseby 10mg –
min every 5-10min to achieveoptimal effect.

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 So dueto thisreason shock istreated dueto
under lying causesof it if whether ishemorrhagic,
or Hypovolemic or anaphylactic
 In all typesof shock restoration of arterial
pressureisessential to maintain perfusion and
blood flow to thebrain.

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 Peoplein shock should betaken by ambulance
to ahospital asquickly aspossible. then, they
should bekept lying down on their back with their
feet raised about afoot higher than their head.
 Administer counter-mediatorssuch asanti-
histamine.

GENERAL PREVENTION OF SHOCK
 Elevatethefoot of thebed to maintain agood
blood supply to thevital organ eg;- brain cells
 Replacement of lost fluidsby infusion or
transfusion.
 Administer oxygen if cyanosisismarked.
 In caseof trauma, giveanalgesic for pain.

CONTINUE
Identify and control sourceof infection
Administer antibiotic
 Removerisk factor for infection

References
Silverman, Adam (Oct 2005). "Shock: A Common Pathway For Life-
Threatening Pediatric Illnesses And Injuries". Pediatric Emergency
Medicine Practice 2 (10).
Tintinalli, Judith E. (2010). Emergency Medicine: A Comprehensive Study
Guide (Emergency Medicine (Tintinalli)). New York: McGraw-Hill
Companies. pp. 165–172. ISBN 0-07-148480-9. Marino, Paul L.
(September 2006). The ICU Book. Lippincott Williams & Wilkins,
Philadelphia & London. ISBN 0-7817-4802-X.
Companies. pp. 174–175. ISBN 0-07-148480-9.
Companies. ISBN 0-07-148480-9.

THANKS FOR
LISTERNING

SHOCK

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SHOCK