1) Shock is a condition where the cardiovascular system fails to adequately perfuse tissues due to impaired cardiac pump function, circulatory issues, or low blood volume.
2) The main types of shock are hypovolemic (low blood volume), cardiogenic (impaired heart function), and distributive (blood vessel problems).
3) Hypovolemic shock results from internal or external fluid loss leading to decreased circulating volume and tissue perfusion. Cardiogenic shock occurs due to impaired left ventricular pumping ability despite normal blood volume.
This document provides an overview of shock, including its classification, causes, pathophysiology, clinical features, and management. It defines shock as a clinical manifestation of inadequate tissue perfusion and cellular hypoxia due to a reduction in effective circulating blood volume. The main types of shock discussed are hypovolemic, cardiogenic, obstructive, distributive, and endocrine shock. The document examines the cellular, microvascular, and systemic pathophysiological changes that occur in shock, as well as compensatory mechanisms and signs of decompensation. Clinical features, diagnosis, and general management principles are also summarized.
The document provides guidance on the nursing management of shock. It discusses assessing the type and phase of shock, providing emergency nursing care, monitoring the patient closely, making a diagnosis based on history and assessments, treating with fluid resuscitation and blood products, and monitoring the patient's response. It also covers age-related considerations and the three phases of shock: compensated, uncompensated, and irreversible.
Shock - Pathophysiology, Clinical Features & ManagementAnkit Sharma
1. Hemorrhagic shock is the most common cause of shock in surgical or trauma patients and results from blood loss that exceeds 15% of circulating volume.
2. Initial management of hemorrhagic shock involves identifying the source of bleeding, providing immediate resuscitation with fluids and blood products, and controlling hemorrhage.
3. Damage control resuscitation principles are followed, including permissive hypotension to limit blood loss and balanced use of crystalloids, colloids, platelets, and plasma to prevent coagulopathy.
This document provides an overview of shock, including its history, definitions, types, pathophysiology, signs and symptoms, and management. It discusses the four main types of shock - cardiogenic, obstructive, hypovolemic, and distributive - describing the insult, physiologic effects, and compensatory mechanisms for each. Treatment of shock focuses on the ABCDE approach - airway, breathing, circulation, disability, and exposure. Restoring adequate circulation through fluid resuscitation is key. The goals of treatment are to optimize oxygen delivery and achieve endpoints of resuscitation like urine output and hemodynamic parameters.
This document provides an overview of the principles of shock management. It defines shock and describes its causes, including hypovolemic, cardiogenic, obstructive, distributive, and endocrine shock. The pathophysiology of shock is explained at the cellular, microvascular, and systemic levels. The stages of shock - non-progressive, progressive decompensated, and decompensated - are outlined. Signs and symptoms of shock are provided. Finally, the document discusses the general management of shock, which aims to improve oxygen delivery and utilization to prevent organ injury through restoration of perfusion and supportive care.
Shock is defined as inadequate tissue perfusion resulting in decreased oxygen delivery and buildup of waste, and can progress from early compensated stages to intermediate stages involving organ damage and late irreversible stages involving multiple organ failure. The document outlines the pathophysiology and stages of shock including effects on body systems, clinical markers, causes, and treatment focusing on restoring tissue perfusion through fluid resuscitation and management of the underlying cause.
This document provides an overview of shock, including its classification, causes, pathophysiology, clinical features, and management. It defines shock as a clinical manifestation of inadequate tissue perfusion and cellular hypoxia due to a reduction in effective circulating blood volume. The main types of shock discussed are hypovolemic, cardiogenic, obstructive, distributive, and endocrine shock. The document examines the cellular, microvascular, and systemic pathophysiological changes that occur in shock, as well as compensatory mechanisms and signs of decompensation. Clinical features, diagnosis, and general management principles are also summarized.
The document provides guidance on the nursing management of shock. It discusses assessing the type and phase of shock, providing emergency nursing care, monitoring the patient closely, making a diagnosis based on history and assessments, treating with fluid resuscitation and blood products, and monitoring the patient's response. It also covers age-related considerations and the three phases of shock: compensated, uncompensated, and irreversible.
Shock - Pathophysiology, Clinical Features & ManagementAnkit Sharma
1. Hemorrhagic shock is the most common cause of shock in surgical or trauma patients and results from blood loss that exceeds 15% of circulating volume.
2. Initial management of hemorrhagic shock involves identifying the source of bleeding, providing immediate resuscitation with fluids and blood products, and controlling hemorrhage.
3. Damage control resuscitation principles are followed, including permissive hypotension to limit blood loss and balanced use of crystalloids, colloids, platelets, and plasma to prevent coagulopathy.
This document provides an overview of shock, including its history, definitions, types, pathophysiology, signs and symptoms, and management. It discusses the four main types of shock - cardiogenic, obstructive, hypovolemic, and distributive - describing the insult, physiologic effects, and compensatory mechanisms for each. Treatment of shock focuses on the ABCDE approach - airway, breathing, circulation, disability, and exposure. Restoring adequate circulation through fluid resuscitation is key. The goals of treatment are to optimize oxygen delivery and achieve endpoints of resuscitation like urine output and hemodynamic parameters.
This document provides an overview of the principles of shock management. It defines shock and describes its causes, including hypovolemic, cardiogenic, obstructive, distributive, and endocrine shock. The pathophysiology of shock is explained at the cellular, microvascular, and systemic levels. The stages of shock - non-progressive, progressive decompensated, and decompensated - are outlined. Signs and symptoms of shock are provided. Finally, the document discusses the general management of shock, which aims to improve oxygen delivery and utilization to prevent organ injury through restoration of perfusion and supportive care.
Shock is defined as inadequate tissue perfusion resulting in decreased oxygen delivery and buildup of waste, and can progress from early compensated stages to intermediate stages involving organ damage and late irreversible stages involving multiple organ failure. The document outlines the pathophysiology and stages of shock including effects on body systems, clinical markers, causes, and treatment focusing on restoring tissue perfusion through fluid resuscitation and management of the underlying cause.
Subject: Medical Surgical Nursing / Adult Health Nursing
Title: Shock
Prepared by: Misfa Khatun, Nursing tutor
Content:
- Introduction
- Definition of Shock
- Classify Shock
- Stages of Shock
- Enumerate the Causes of shock
- Pathophysiology of Shock
- Identify the Signs and symptoms of Shock
- First ais management of Shock
- Treatment of Shock
- Management of Shock
- Nursing management of Shock
This document defines blood transfusion and discusses its purposes, situations where it is needed, potential reactions, and nursing interventions for reactions. It also classifies different blood products, how they are used, and blood compatibility. Specifically, it states that blood transfusion is a procedure where a patient receives blood products intravenously. Its main purposes are to replace lost blood from injury or surgery, restore oxygen levels, and provide clotting factors. Potential reactions include hemolytic, febrile, allergic, circulatory overload, and sepsis. Nursing interventions depend on the reaction but may include stopping the transfusion and notifying the provider. The document also describes various blood products like packed red blood cells, plasma, platelets, and
This document discusses the diagnosis and management of shock. It defines shock as impaired tissue oxygenation and perfusion that can lead to organ dysfunction and death if left untreated. The document classifies shock into 4 main categories: hypovolemic, cardiogenic, distributive, and obstructive. It then describes the key clinical features, causes, and goals of treatment for each type of shock. The general principles of shock management are also summarized, which include treating the underlying cause, restoring adequate perfusion and tissue oxygen delivery, and reducing oxygen demand through supportive care.
1. Hypovolemic shock is caused by a reduction in blood volume from bleeding, dehydration, or fluid shifts. It results in decreased cardiac output and blood pressure leading to low tissue perfusion. Treatment involves replacing fluid and blood volume.
2. Cardiogenic shock occurs when the heart cannot adequately pump blood, often due to a heart attack. It causes low blood pressure and tissue hypoxia. Treatment focuses on correcting the underlying cause and supporting hemodynamics.
3. Septic shock results from a widespread infection that activates an inflammatory response impairing tissue perfusion. Treatment involves antibiotics, fluid resuscitation, and controlling the infection.
This document provides an overview of shock and its management. It defines shock as an acute medical condition associated with a fall in blood pressure caused by events such as blood loss, burns, allergic reactions or sudden emotional stress. The causes of shock are discussed as cardiogenic, hypovolemic, neurogenic, anaphylactic and septic. Signs and symptoms and classification of hemorrhage are outlined. General management principles like airway maintenance, oxygen administration, IV fluids and blood transfusion are described. Surgical and local methods of hemorrhage control are also summarized. Finally, the spectrum of infections from bacteremia to septic shock and MODS as well as the treatment approach of antibiotics, source control
The document provides an overview of shock, including its pathophysiology, classification, signs and symptoms, and treatment approaches. Shock is defined as inadequate tissue perfusion and oxygenation leading to cellular dysfunction. There are several types of shock including hypovolemic, cardiogenic, obstructive, and distributive shock. Treatment involves identifying and treating the underlying cause while rapidly restoring circulating volume and hemodynamics through fluid resuscitation and vasopressors if needed. Ongoing monitoring of vital signs, urine output, lactate levels, and other parameters is important to guide resuscitation efforts and evaluate tissue perfusion.
This document defines and discusses the pathophysiology of different types of shock: cardiogenic, obstructive, hypovolemic, and distributive. It notes that shock occurs when there is inadequate perfusion and oxygenation of cells, leading to cellular and organ dysfunction. The key signs of shock include tachycardia, hypotension, altered mental status, and decreased urine output. Early goal-directed resuscitation is important to prevent end organ damage and death, and should focus on airway management, oxygenation, fluid resuscitation, and treating the underlying cause.
SHOCK - PATHOPHYSIOLOGY, TYPES, APPROACH, TREATMENT.DR K TARUN RAO
1. Shock is defined as a state of poor tissue perfusion and cellular metabolism due to circulatory failure and hypoperfusion.
2. The main causes of shock include hypovolemic, cardiogenic, septic, anaphylactic, neurogenic, and respiratory etiologies.
3. The pathophysiology of shock involves a low cardiac output state leading to vasoconstriction and redistribution of blood flow away from non-vital organs to preserve perfusion of vital organs. Persistent shock can progress to cellular damage, organ dysfunction, and death.
Shock is defined as acute circulatory failure resulting in inadequate tissue perfusion and oxygen utilization. Abnormalities in tissue perfusion can be caused by heart failure, impediments to blood flow, loss of circulating volume, or issues with the peripheral circulation. The clinical features of shock vary depending on the specific type but may include signs of low blood pressure, increased heart rate, pale and cool skin, decreased urine output, altered mental status, and metabolic acidosis. Assessment of tissue perfusion through skin signs, lactate levels, and urine output can help evaluate the severity of shock.
Cardiogenic shock is a condition of diminished cardiac output that severely impairs cardiac perfusion. In this condition in which the heart suddenly can't pump enough blood to meet the body's needs.
This document discusses septic shock, including its definition, risk factors, signs and symptoms, pathophysiology, diagnostic tests, and medical and nursing management. Septic shock is a serious condition that occurs when a body-wide infection leads to dangerously low blood pressure and multiorgan failure. It can result from sepsis when blood pressure drops dangerously low despite fluid resuscitation. Management involves identifying and treating the infection through antibiotics, supporting failing organs, and maintaining adequate tissue perfusion and oxygen delivery.
Shock is a condition where the cardiovascular system fails to adequately perfuse tissues. It can be caused by an impaired pump (cardiogenic shock), reduced circulating volume (hypovolemic shock), or maldistribution of blood flow (distributive shock). The main effects are cellular hypoxia, impaired metabolism, and organ damage or failure if not treated. Compensatory mechanisms aim to increase perfusion but eventually fail, leading to irreversible cellular damage and death if shock persists.
The document discusses different types of shock including hypovolumic, cardiogenic, septic, anaphylactic, and neurogenic shock. It defines shock as systemic hypoperfusion caused by reduced cardiac output or effective circulatory blood volume. Key signs are hypotension, tissue hypoperfusion, cellular hypoxia, and potential end organ dysfunction. Management involves treating the underlying cause, restoring circulating volume, providing vasoactive drugs and oxygenation support, and monitoring for multiple organ failure in intensive care. Prognosis depends on the shock type and duration, with septic and cardiogenic shock having higher mortality risks.
1. Cardiogenic shock is defined as a cardiac output less than 2.2 L/minute/m2 due to pathology in the heart itself. It can be caused by myocardial infarction, trauma, myocarditis, cardiomyopathy or sepsis.
2. Diagnosis is based on hypotension, reduced cardiac index, elevated pulmonary capillary wedge pressure, and signs of low cardiac output like tachycardia, hypotension, elevated jugular venous pressure, and oliguria.
3. Initial management involves treating the underlying cause, optimizing preload and afterload, and using inotropic support and vasopressors if needed.
The document discusses the different types of shock: hypovolemic, cardiogenic, circulatory (septic, neurogenic, anaphylactic), and endocrine shock. It provides details on the causes, pathophysiology, clinical manifestations, medical management, and nursing management of each type of shock. The primary types covered are hypovolemic, cardiogenic, septic, neurogenic, and anaphylactic shock.
Hypovolemic shock is a life-threatening condition caused by a reduction in circulating blood volume, resulting in decreased oxygen delivery. Early recognition is important to avoid tissue injury. Hypovolemic shock can be hemorrhagic, caused by blood loss from trauma or gastrointestinal bleeding, or non-hemorrhagic due to causes like burns, diarrhea, or excessive diuresis. Treatment involves rapid fluid resuscitation with crystalloids to restore circulating volume, with goals of maintaining an adequate blood pressure depending on the cause of shock. Lactate levels should be monitored to assess tissue perfusion.
1. A blood transfusion involves transferring blood or blood products from a donor to a recipient. It is often done to replace blood lost through severe bleeding.
2. There are different types of blood transfusions depending on when the blood is collected and transfused. These include pre-operative autologous donation, intra-operative autologous transfusion, and post-operative autologous transfusion.
3. Blood banks collect, test, and store blood products. They screen donations for infectious agents and determine blood type to ensure compatible transfusions. A transfusion is prepared by selecting a compatible blood type, and then confirming compatibility through cross-matching before transfusion.
This document discusses the pathophysiology, causes, and management of shock. Shock is defined as a state of circulatory insufficiency resulting in inadequate organ perfusion. There are several types of shock, including hypovolemic, vasodilatory, cardiogenic, neurogenic, and obstructive. The initial goals of management are to secure the airway, administer intravenous fluids and vasopressors to restore perfusion pressure and tissue oxygenation, and give antibiotics if infection is suspected. The ultimate treatment involves addressing the underlying cause while monitoring systemic and tissue parameters to guide resuscitation efforts until oxygen debt is repaid and aerobic metabolism is restored.
Shock is a life-threatening condition where the body's tissues do not receive enough blood flow and oxygen. There are several types of shock including cardiogenic, hypovolemic, obstructive, and distributive shock. Distributive shock includes anaphylactic, septic, and neurogenic shock. Shock progresses through initial, progressive, and irreversible stages characterized by worsening signs and symptoms as compensatory mechanisms fail. Treatment depends on the underlying cause but aims to restore adequate blood flow and oxygen delivery to tissues.
This document provides an overview of shock, including its definition, types, etiology, pathogenesis, stages, and pathophysiological changes. It discusses the classification of shock into types such as hypovolemic, septic, traumatic, neurogenic, and distributive shock. For septic shock specifically, it covers the etiology as severe infection, pathophysiology involving the immune response and release of toxins, and key features including hypotension, tissue hypoperfusion, and high mortality rates. Treatment focuses on fluid resuscitation and source control for hypovolemic and septic shock.
This document discusses shock and its pathogenesis through microcirculation changes. It begins with definitions of shock and classifications based on etiology. It then explains the microcirculation theory of shock and describes the three stages of microcirculation changes: 1) ischemic hypoxia stage characterized by vasoconstriction, 2) stagnant hypoxia stage with over-activation of the sympathetic nervous system leading to stasis, and 3) refractory stage of irreversible microcirculatory failure. Key concepts include compensatory mechanisms in early shock, the role of humoral factors and cellular mechanisms in later stages, and principles of treatment tailored to the stage of shock.
This document provides guidance on vascular access procedures for pediatric patients. It discusses:
1) The importance of rapid vascular access for fluid resuscitation and drug administration during emergencies. Intraosseous access should be prioritized if IV access cannot be quickly achieved.
2) Procedures for establishing intraosseous, peripheral, central, and femoral venous access.
3) The importance of following universal precautions during all vascular access procedures.
Subject: Medical Surgical Nursing / Adult Health Nursing
Title: Shock
Prepared by: Misfa Khatun, Nursing tutor
Content:
- Introduction
- Definition of Shock
- Classify Shock
- Stages of Shock
- Enumerate the Causes of shock
- Pathophysiology of Shock
- Identify the Signs and symptoms of Shock
- First ais management of Shock
- Treatment of Shock
- Management of Shock
- Nursing management of Shock
This document defines blood transfusion and discusses its purposes, situations where it is needed, potential reactions, and nursing interventions for reactions. It also classifies different blood products, how they are used, and blood compatibility. Specifically, it states that blood transfusion is a procedure where a patient receives blood products intravenously. Its main purposes are to replace lost blood from injury or surgery, restore oxygen levels, and provide clotting factors. Potential reactions include hemolytic, febrile, allergic, circulatory overload, and sepsis. Nursing interventions depend on the reaction but may include stopping the transfusion and notifying the provider. The document also describes various blood products like packed red blood cells, plasma, platelets, and
This document discusses the diagnosis and management of shock. It defines shock as impaired tissue oxygenation and perfusion that can lead to organ dysfunction and death if left untreated. The document classifies shock into 4 main categories: hypovolemic, cardiogenic, distributive, and obstructive. It then describes the key clinical features, causes, and goals of treatment for each type of shock. The general principles of shock management are also summarized, which include treating the underlying cause, restoring adequate perfusion and tissue oxygen delivery, and reducing oxygen demand through supportive care.
1. Hypovolemic shock is caused by a reduction in blood volume from bleeding, dehydration, or fluid shifts. It results in decreased cardiac output and blood pressure leading to low tissue perfusion. Treatment involves replacing fluid and blood volume.
2. Cardiogenic shock occurs when the heart cannot adequately pump blood, often due to a heart attack. It causes low blood pressure and tissue hypoxia. Treatment focuses on correcting the underlying cause and supporting hemodynamics.
3. Septic shock results from a widespread infection that activates an inflammatory response impairing tissue perfusion. Treatment involves antibiotics, fluid resuscitation, and controlling the infection.
This document provides an overview of shock and its management. It defines shock as an acute medical condition associated with a fall in blood pressure caused by events such as blood loss, burns, allergic reactions or sudden emotional stress. The causes of shock are discussed as cardiogenic, hypovolemic, neurogenic, anaphylactic and septic. Signs and symptoms and classification of hemorrhage are outlined. General management principles like airway maintenance, oxygen administration, IV fluids and blood transfusion are described. Surgical and local methods of hemorrhage control are also summarized. Finally, the spectrum of infections from bacteremia to septic shock and MODS as well as the treatment approach of antibiotics, source control
The document provides an overview of shock, including its pathophysiology, classification, signs and symptoms, and treatment approaches. Shock is defined as inadequate tissue perfusion and oxygenation leading to cellular dysfunction. There are several types of shock including hypovolemic, cardiogenic, obstructive, and distributive shock. Treatment involves identifying and treating the underlying cause while rapidly restoring circulating volume and hemodynamics through fluid resuscitation and vasopressors if needed. Ongoing monitoring of vital signs, urine output, lactate levels, and other parameters is important to guide resuscitation efforts and evaluate tissue perfusion.
This document defines and discusses the pathophysiology of different types of shock: cardiogenic, obstructive, hypovolemic, and distributive. It notes that shock occurs when there is inadequate perfusion and oxygenation of cells, leading to cellular and organ dysfunction. The key signs of shock include tachycardia, hypotension, altered mental status, and decreased urine output. Early goal-directed resuscitation is important to prevent end organ damage and death, and should focus on airway management, oxygenation, fluid resuscitation, and treating the underlying cause.
SHOCK - PATHOPHYSIOLOGY, TYPES, APPROACH, TREATMENT.DR K TARUN RAO
1. Shock is defined as a state of poor tissue perfusion and cellular metabolism due to circulatory failure and hypoperfusion.
2. The main causes of shock include hypovolemic, cardiogenic, septic, anaphylactic, neurogenic, and respiratory etiologies.
3. The pathophysiology of shock involves a low cardiac output state leading to vasoconstriction and redistribution of blood flow away from non-vital organs to preserve perfusion of vital organs. Persistent shock can progress to cellular damage, organ dysfunction, and death.
Shock is defined as acute circulatory failure resulting in inadequate tissue perfusion and oxygen utilization. Abnormalities in tissue perfusion can be caused by heart failure, impediments to blood flow, loss of circulating volume, or issues with the peripheral circulation. The clinical features of shock vary depending on the specific type but may include signs of low blood pressure, increased heart rate, pale and cool skin, decreased urine output, altered mental status, and metabolic acidosis. Assessment of tissue perfusion through skin signs, lactate levels, and urine output can help evaluate the severity of shock.
Cardiogenic shock is a condition of diminished cardiac output that severely impairs cardiac perfusion. In this condition in which the heart suddenly can't pump enough blood to meet the body's needs.
This document discusses septic shock, including its definition, risk factors, signs and symptoms, pathophysiology, diagnostic tests, and medical and nursing management. Septic shock is a serious condition that occurs when a body-wide infection leads to dangerously low blood pressure and multiorgan failure. It can result from sepsis when blood pressure drops dangerously low despite fluid resuscitation. Management involves identifying and treating the infection through antibiotics, supporting failing organs, and maintaining adequate tissue perfusion and oxygen delivery.
Shock is a condition where the cardiovascular system fails to adequately perfuse tissues. It can be caused by an impaired pump (cardiogenic shock), reduced circulating volume (hypovolemic shock), or maldistribution of blood flow (distributive shock). The main effects are cellular hypoxia, impaired metabolism, and organ damage or failure if not treated. Compensatory mechanisms aim to increase perfusion but eventually fail, leading to irreversible cellular damage and death if shock persists.
The document discusses different types of shock including hypovolumic, cardiogenic, septic, anaphylactic, and neurogenic shock. It defines shock as systemic hypoperfusion caused by reduced cardiac output or effective circulatory blood volume. Key signs are hypotension, tissue hypoperfusion, cellular hypoxia, and potential end organ dysfunction. Management involves treating the underlying cause, restoring circulating volume, providing vasoactive drugs and oxygenation support, and monitoring for multiple organ failure in intensive care. Prognosis depends on the shock type and duration, with septic and cardiogenic shock having higher mortality risks.
1. Cardiogenic shock is defined as a cardiac output less than 2.2 L/minute/m2 due to pathology in the heart itself. It can be caused by myocardial infarction, trauma, myocarditis, cardiomyopathy or sepsis.
2. Diagnosis is based on hypotension, reduced cardiac index, elevated pulmonary capillary wedge pressure, and signs of low cardiac output like tachycardia, hypotension, elevated jugular venous pressure, and oliguria.
3. Initial management involves treating the underlying cause, optimizing preload and afterload, and using inotropic support and vasopressors if needed.
The document discusses the different types of shock: hypovolemic, cardiogenic, circulatory (septic, neurogenic, anaphylactic), and endocrine shock. It provides details on the causes, pathophysiology, clinical manifestations, medical management, and nursing management of each type of shock. The primary types covered are hypovolemic, cardiogenic, septic, neurogenic, and anaphylactic shock.
Hypovolemic shock is a life-threatening condition caused by a reduction in circulating blood volume, resulting in decreased oxygen delivery. Early recognition is important to avoid tissue injury. Hypovolemic shock can be hemorrhagic, caused by blood loss from trauma or gastrointestinal bleeding, or non-hemorrhagic due to causes like burns, diarrhea, or excessive diuresis. Treatment involves rapid fluid resuscitation with crystalloids to restore circulating volume, with goals of maintaining an adequate blood pressure depending on the cause of shock. Lactate levels should be monitored to assess tissue perfusion.
1. A blood transfusion involves transferring blood or blood products from a donor to a recipient. It is often done to replace blood lost through severe bleeding.
2. There are different types of blood transfusions depending on when the blood is collected and transfused. These include pre-operative autologous donation, intra-operative autologous transfusion, and post-operative autologous transfusion.
3. Blood banks collect, test, and store blood products. They screen donations for infectious agents and determine blood type to ensure compatible transfusions. A transfusion is prepared by selecting a compatible blood type, and then confirming compatibility through cross-matching before transfusion.
This document discusses the pathophysiology, causes, and management of shock. Shock is defined as a state of circulatory insufficiency resulting in inadequate organ perfusion. There are several types of shock, including hypovolemic, vasodilatory, cardiogenic, neurogenic, and obstructive. The initial goals of management are to secure the airway, administer intravenous fluids and vasopressors to restore perfusion pressure and tissue oxygenation, and give antibiotics if infection is suspected. The ultimate treatment involves addressing the underlying cause while monitoring systemic and tissue parameters to guide resuscitation efforts until oxygen debt is repaid and aerobic metabolism is restored.
Shock is a life-threatening condition where the body's tissues do not receive enough blood flow and oxygen. There are several types of shock including cardiogenic, hypovolemic, obstructive, and distributive shock. Distributive shock includes anaphylactic, septic, and neurogenic shock. Shock progresses through initial, progressive, and irreversible stages characterized by worsening signs and symptoms as compensatory mechanisms fail. Treatment depends on the underlying cause but aims to restore adequate blood flow and oxygen delivery to tissues.
This document provides an overview of shock, including its definition, types, etiology, pathogenesis, stages, and pathophysiological changes. It discusses the classification of shock into types such as hypovolemic, septic, traumatic, neurogenic, and distributive shock. For septic shock specifically, it covers the etiology as severe infection, pathophysiology involving the immune response and release of toxins, and key features including hypotension, tissue hypoperfusion, and high mortality rates. Treatment focuses on fluid resuscitation and source control for hypovolemic and septic shock.
This document discusses shock and its pathogenesis through microcirculation changes. It begins with definitions of shock and classifications based on etiology. It then explains the microcirculation theory of shock and describes the three stages of microcirculation changes: 1) ischemic hypoxia stage characterized by vasoconstriction, 2) stagnant hypoxia stage with over-activation of the sympathetic nervous system leading to stasis, and 3) refractory stage of irreversible microcirculatory failure. Key concepts include compensatory mechanisms in early shock, the role of humoral factors and cellular mechanisms in later stages, and principles of treatment tailored to the stage of shock.
This document provides guidance on vascular access procedures for pediatric patients. It discusses:
1) The importance of rapid vascular access for fluid resuscitation and drug administration during emergencies. Intraosseous access should be prioritized if IV access cannot be quickly achieved.
2) Procedures for establishing intraosseous, peripheral, central, and femoral venous access.
3) The importance of following universal precautions during all vascular access procedures.
Shock is a clinical condition caused by inadequate tissue perfusion leading to cellular ischemia. The main causes of death in surgical patients are from shock. Shock can be classified as cardiogenic, hypovolemic, distributive, or obstructive. The key features of shock are hypotension, tachycardia, altered mental status, and signs of poor peripheral perfusion. Treatment involves rapid fluid resuscitation to restore perfusion, with blood products as needed. Ongoing fluid needs and use of vasopressors depends on the type and severity of shock. Monitoring includes vital signs, urine output, lactate, and base deficit to guide resuscitation efforts until tissues are fully resuscitated.
Hemodynamic monitoring involves measuring and monitoring the factors that influence blood flow and pressure in the body. It is concerned with five main areas: the right heart, lungs, left heart, fluid status, and blood pressures. Normal hemodynamic values include a central venous pressure of 2-6 mmHg, pulmonary artery pressure of 6-15 mmHg, pulmonary capillary wedge pressure of 6-12 mmHg, and a cardiac output of 4-8 L/min. Treatment for different types of shock depends on the underlying cause but may include inotropes, vasopressors, antibiotics, and fluid resuscitation.
This chapter discusses shock, which occurs when inadequate blood flow and oxygen reach the cells of the body. The stages of shock are compensated, decompensated, and irreversible shock. Causes include cardiovascular issues like heart failure or blood loss, respiratory problems, allergic reactions, and psychogenic causes like fainting. Treatment involves controlling bleeding, keeping the victim warm and still, administering epinephrine for allergic reactions, and seeking immediate medical care.
1) The first priority in managing shock is stabilizing the patient's airway, breathing, and circulation through oxygen administration, intubation if needed, and assessing perfusion.
2) Early management also includes choosing between crystalloid or colloid replacement fluids, administering fluids rapidly through large volume infusion, and using vasopressors if the patient does not respond to initial fluid resuscitation.
3) Septic shock is defined as sepsis with hypotension that persists after initial fluid resuscitation, and may require inotropes in addition to vasopressors and fluids to restore adequate perfusion.
This document provides an excerpt from a textbook chapter on sampling distributions. It discusses the distribution of the sample mean and sample proportion. For the sample mean, it explains that the sampling distribution is approximately normal for large sample sizes based on the Central Limit Theorem, even if the population is not normally distributed. It gives examples of estimating sampling distributions through simulation. For the sample proportion, it defines the point estimate of a population proportion from a sample and describes how the sampling distribution of the sample proportion becomes approximately normal as the sample size increases. It provides formulas for the mean and standard deviation of sampling distributions.
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Jacobo Maria Sandoval has over 10 years of experience supervising operations and implementing continuous improvements. He has a strong background in lean manufacturing, inventory management, production planning, and staff supervision. As an operations supervisor, he has reduced costs, improved efficiencies and productivity, and ensured compliance with safety and quality regulations across various roles in warehousing, manufacturing, and maintenance.
This document provides information on shock, including its definition, types, pathophysiology, clinical features, and management. It defines shock as a state of inadequate tissue perfusion and oxygenation that can lead to organ dysfunction and death. The main types of shock discussed are hypovolemic, septic, and cardiogenic shock. For each type, the document outlines their pathophysiology, signs and symptoms, and general management approach. Overall, it serves as an overview of shock for medical students, covering the essential details of definitions, types, effects on organ systems, and clinical distinctions between compensated and decompensated states of shock.
Shock occurs when arterial blood flow is inadequate to meet metabolic needs, resulting from cardiovascular collapse. The main types are hypovolemic, cardiogenic, and distributive shock. Hypovolemic shock results from decreased intravascular volume due to blood, plasma, or fluid loss. Cardiogenic shock is caused by pump failure from myocardial damage or obstruction. Distributive shock reduces vascular resistance from sepsis, anaphylaxis, or SIRS. The body initially compensates for shock but decompensation occurs when mechanisms fail, potentially progressing to irreversible shock without treatment.
Shock is a life-threatening condition caused by inadequate tissue perfusion. It has several stages from initial to irreversible. The main types are hypovolemic, cardiogenic, obstructive, distributive, and neurogenic. Hypovolemic shock results from a loss of intravascular volume and is the most common type. Diagnosis involves assessing vital signs and fluid status. Treatment focuses on restoring volume with fluids and blood products, addressing the underlying cause, and supporting organ function. Close monitoring for complications is important during resuscitation.
Shock, including hemorrhagic shock, results from inadequate tissue perfusion leading to hypoxia and cellular dysfunction. Hemorrhagic shock specifically is caused by hypovolemia from blood or fluid loss, leading to decreased blood pressure and organ ischemia. It can be classified based on severity of blood loss and signs/symptoms, and treatment involves controlling bleeding, rapid fluid resuscitation, and treating complications like multiple organ failure and coagulopathy that can result from severe or prolonged shock.
This document discusses shock, including its definition, pathophysiology, types, stages, and effects on body systems. Shock is defined as a failure of the circulatory system to maintain adequate organ perfusion. The main types are hypovolemic, cardiogenic, and distributive shock. The stages include initial, nonprogressive, progressive, and refractory. Effects include tissue hypoxia, acid-base imbalances, coagulopathies, and end-organ damage. General signs are tachypnea, tachycardia, hypotension, altered mental status, and oliguria. Early goal-directed resuscitation is important to prevent progression to irreversible shock.
This document provides an overview of shock, including its definition, pathophysiology, classification, signs and symptoms, initial management, and specific types such as hypovolemic, septic, cardiogenic, and obstructive shock. It defines shock as inadequate tissue perfusion and oxygen delivery, discusses the body's compensatory mechanisms and their failure in severe shock. It classifies shock into hypovolemic, cardiogenic, distributive, and obstructive types and provides details on managing each type, including damage control resuscitation for hemorrhagic shock and use of vasopressors for neurogenic shock. Key goals in shock management are outlined as well as factors like lactate and base deficit that can guide res
Hypovolemic shock results from trauma that causes blood loss, decreasing blood volume and lowering blood pressure. The body initially compensates through mechanisms like catecholamine release, but can progress to decompensated then irreversible shock if left untreated. Treatment focuses on fluid resuscitation through IV fluids to restore blood volume.
Cardiogenic shock occurs when the heart cannot adequately circulate blood, usually due to a heart attack damaging the left ventricle. It presents with pulmonary edema but normal blood pressures. Treatment centers on supportive care while the heart recovers.
Neurogenic shock is caused by spinal cord injury disrupting nerve signals, causing widespread vessel dilation and low blood pressure. It presents with warm skin and
Hemorrhagic shock results from significant blood or fluid loss leading to inadequate tissue perfusion. The main mechanisms are hypovolemia from external or internal bleeding, which decreases preload and blood pressure. This causes vasoconstriction and ischemia of vital organs. Without treatment, ischemia progresses to multi-organ failure and death. Management involves controlling bleeding, fluid resuscitation, and treating for shock, while monitoring for deterioration. Direct pressure, elevation, pressure points and tourniquets can help stop bleeding from extremities until definitive care.
1) Shock is characterized by decreased tissue perfusion and cellular metabolism due to an imbalance between oxygen supply and demand. It can be classified as low blood flow shock (cardiogenic, hypovolemic) or maldistribution of blood flow shock (septic, anaphylactic, neurogenic).
2) Management of shock involves identifying the cause, restoring circulating volume through fluid resuscitation, supporting vital organ function, and treating the underlying cause. General management strategies include ensuring a patent airway, maximizing oxygen delivery, and volume expansion with isotonic crystalloids.
3) The stages of shock include initial, compensated, progressive, and refractory. Treatment aims to support compensation and prevent progression
Heart failure is a common condition where the heart is unable to pump enough blood to meet the body's needs. It can result from structural or functional disorders of the heart. The document provides details on the definition, causes, risk factors, pathophysiology, symptoms, diagnostic evaluation, classification systems, and treatment of heart failure. It emphasizes the importance of controlling risk factors, using medications such as ACE inhibitors and diuretics to manage symptoms, and making lifestyle changes like following a low-sodium diet and exercising regularly.
This document provides information on shock, including its definition, physiology, pathophysiology, types, symptoms, signs, management, and treatment. It defines shock as inadequate perfusion leading to inadequate oxygen delivery to tissues. The stages of shock are described as initial, compensatory, progressive, and irreversible. Types of shock include cardiogenic, hypovolemic, neurogenic, septic, anaphylactic, and obstructive shock. Signs and symptoms result from cellular hypoperfusion and include restlessness, tachycardia, decreased consciousness, nausea, and decreased urine output. Management involves treating the underlying cause, giving oxygen, intravenous fluids, and vasopressors if needed. The goal of treatment is
Shock is a life-threatening condition defined by inadequate tissue perfusion and oxygen delivery. It can be caused by hypovolemia, cardiac dysfunction, or vasodilation. The main symptoms include low blood pressure, fast heart rate, fast breathing, and decreased urine output. Untreated shock can lead to organ failure and death. Treatment focuses on restoring circulating volume and oxygen delivery through fluid resuscitation, vasopressors, and treating the underlying cause. Prompt recognition and treatment are essential for recovery.
Shock
what is shock
stages of shock
types of shock, their presentation and management
presentation is made for medical students using kumar and clark and guyton.
The patient presented with signs of septic shock including altered mental status, tachypnea, and hypotension. He has a history of multiple comorbidities putting him at risk for infection. Initial workup showed bilateral lung crepitations and fever, suggestive of pneumonia as the source of sepsis. Management involved fluid resuscitation, vasopressors to maintain blood pressure, broad-spectrum antibiotics, and monitoring for signs of organ dysfunction due to systemic inflammatory response.
Shock is characterized by impaired cellular metabolism and decreased tissue perfusion. There are four main types of shock: hypovolemic, vasogenic, cardiogenic, and neurogenic. The stages of shock progression include initial, compensatory, progressive, and irreversible. Management aims to restore fluid volume, increase cardiac output, and remove the precipitating cause. Nursing care focuses on monitoring vital signs, administering IV fluids and oxygen, maintaining perfusion, preventing complications, and supporting organ function.
1. Shock is a systemic state of low tissue perfusion that is inadequate for normal cellular respiration. It can be caused by various factors like blood loss, heart problems, or sepsis.
2. In trauma patients, shock is a common cause of death second only to traumatic brain injury. The Advanced Trauma Life Support (ATLS) protocol is used to assess and treat patients in shock.
3. Shock is classified into stages from initial to irreversible based on the body's attempts at compensation. Fluid resuscitation is used to treat hypovolemic shock, with blood transfusion as needed to replace lost volume. Dynamic fluid monitoring helps determine fluid responsiveness.
Haemorrhagic shock results from hypovolemia due to blood loss, leading to decreased preload and increased sympathetic activity. This causes vasoconstriction and decreased blood pressure, resulting in ischemia and eventual multi-organ failure. Classification of hemorrhagic shock ranges from 15-40% blood loss with compensated mechanisms maintaining blood pressure initially, but ultimately leading to uncompensated shock. Management focuses on controlling hemorrhage, fluid resuscitation, and blood transfusion to restore volume. Massive blood transfusion is loosely defined as over 10 units in 24 hours or 50% blood volume replacement in 12 hours, with general indications being hemorrhagic shock and anemia in critical illness.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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Shock for BS Medical technologist
1. Shock
Types, recognition and therapyTypes, recognition and therapy
Maciej Dudkiewicz M.D. Ph.D.
Dpt of Anaesthesia and Intensive
Care
Medical University of Lodz
2. SHOCK SYNDROMESHOCK SYNDROME
• Shock is a condition in which the cardiovascular system
fails to perfuse tissues adequately
• An impaired cardiac pump, circulatory system, and/or
volume can lead to compromised blood flow to tissues
• Inadequate tissue perfusion can result in:• Inadequate tissue perfusion can result in:
– generalized cellular hypoxia (starvation)
– widespread impairment of cellular metabolism
– tissue damage organ failure
– death
3. PATHOPHYSIOLOGYPATHOPHYSIOLOGY
Cells switch from aerobic to anaerobic metabolism
lactic acid production
Cell function ceases & swells
membrane becomes more permeable
electrolytes & fluids seep in & out of cell
Na+/K+ pump impaired
mitochondria damage
cell death
5. COMPENSATORY MECHANISMS:
Sympathetic Nervous System (SNS)-Adrenal
Response
• SNS - Hormonal: Renin-angiotension system
Decrease renal perfusion
Releases renin angiotension IReleases renin angiotension I
angiotension II potent vasoconstriction &
releases aldosterone adrenal cortex
sodium & water retention
6. COMPENSATORY MECHANISMS:
Sympathetic Nervous System (SNS)-Adrenal
Response
• SNS - Hormonal: Antidiuretic Hormone
Osmoreceptors in hypothalamus stimulated
ADH released by Posterior pituitary gland
Vasopressor effect to increase BP
Acts on renal tubules to retain water
8. Failure of Compensatory Response
• Decreased blood flow to the tissues causes
cellular hypoxia
• Anaerobic metabolism begins
• Cell swelling, mitochondrial disruption, and• Cell swelling, mitochondrial disruption, and
eventual cell death
• If Low Perfusion States persists:
IRREVERSIBLE DEATH IMMINENT!!
9. Stages of Shock
Initial stage - tissues are under perfused, decreased CO,
increased anaerobic metabolism, lactic acid is building
Compensatory stage - Reversible. SNS activated by
low CO, attempting to compensate for the decrease tissue
perfusion.perfusion.
Progressive stage - Failing compensatory mechanisms:
profound vasoconstriction from the SNS ISCHEMIA
Lactic acid production is high metabolic acidosis
Irreversible or refractory stage - Cellular necrosis
and Multiple Organ Dysfunction Syndrome may occur
DEATH IS IMMINENT!!!!
10. Pathophysiology Systemic Level
•Net results of cellular shock:
systemic lactic acidosis
decreased myocardial contractilitydecreased myocardial contractility
decreased vascular tone
decrease blood pressure, preload, and
cardiac output
11. Shock SyndromesShock Syndromes
• Hypovolemic Shock
–blood VOLUME problem
• Cardiogenic Shock• Cardiogenic Shock
–blood PUMP problem
• Distributive Shock
[septic;anaphylactic;neurogenic]
–blood VESSEL problem
12. Hypovolemic Shock
• Loss of circulating volume “Empty tank ”
decrease tissue perfusion general shock response
• ETIOLOGY:
–Internal or External fluid loss–Internal or External fluid loss
– Intracellular and extracellular compartments
• Most common causes:
Hemmorhage
Dehydration
13. Hypovolemic Shock: External loss
of fluid
• Fluid loss: Dehydration
– Nausea & vomiting, diarrhea, massive diuresis,
extensive burns
• Blood loss:
– trauma: blunt and penetrating
– BLOOD YOU SEE
– BLOOD YOU DON’T SEE
14. Hypovolemic Shock: Internal fluid loss
• Loss of Intravascular integrity
• Increased capillary membrane permeability
• Decreased Colloidal Osmotic Pressure
(third spacing)
17. Assessment & Management
S/S vary depending on severity of fluid loss:
• 15%[750ml]- compensatory mechanism maintains CO
• 15-30% [750-1500ml- Hypoxemia, decreased BP & UOP• 15-30% [750-1500ml- Hypoxemia, decreased BP & UOP
• 30-40% [1500-2000ml] -Impaired compensation &
profound shock along with severe acidosis
• 40-50% - refactory stage:
loss of volume= death
19. Therapy of hypovolaemic shock
• Airway / breathing / C/spine control
• Stop all obvious haemorrhage
• Insert I.v. lines, take blood for X-match• Insert I.v. lines, take blood for X-match
• Give rapid bolus of fluid, then assess
response
• Decide on need for surgery vs. decision to
investigate
20. Colloid vs. crystalloid
• Large meta-analysis (BMJ, 1998) suggested
that colloid associated with less pulmonary
oedema, lower volumes but equal mortalityoedema, lower volumes but equal mortality
• Crystalloid produces smaller rise in BP, and
more hypothermia
• NB gelatines and ACE inhibitors
21. Intravenous Access
• the rate of volume infusion is determined by the
dimensions of the vascular catheter, not by the size of
the vein
• cannulation of the large central veins requires• cannulation of the large central veins requires
catheters that are at least 5 inches in length, whereas
cannulation of peripheral veins can be accomplished
with catheters that are 2 inches in length
23. Intravenous Access
• central venous cannulation is reserved for monitoring
cardiac filling pressures and venous O2 saturation
unless very-large-bore introducer catheters are used
for volume resuscitationfor volume resuscitation
• central venous catheters are 3 to 4 times longer than
peripheral venous catheters, the infusion rate
through central catheters will be as much as 75%
less than the infusion rate through peripheral
catheters (of equal diameter)
24. Resuscitation Endpoints
• The following are common endpoints of
volume resuscitation:
1. CVP = 15 mm Hg
2. Wedge pressure = 10 to 12 mmHg2. Wedge pressure = 10 to 12 mmHg
3. Cardiac index > 3 L/min/m2
4. Blood lactate < 4 mmol/L
5. Base deficit -3 to +3 mmol/L
30. Cardiogenic Shock:
Pathophysiology
• Impaired pumping ability of LV leads to…
Decreased stroke volume leads to…..Decreased stroke volume leads to…..
Decreased CO leads to …..
Decreased BP leads to…..
Compensatory mechanism which may lead to …
Decreased tissue perfusion !!!!
31. Cardiogenic Shock:
Pathophysiology
• Impaired pumping ability of LV leads to…
Inadequate systolic emptying leads to ...
Left ventricular filling pressures (preload) leads Left ventricular filling pressures (preload) leads
to...
Left atrial pressures leads to ….
Pulmonary capillary pressure leads to …
Pulmonary interstitial & intraalveolar edema
!!!!
32. Clinical Presentation
Cardiogenic Shock
• Similar catecholamine compensation changes in
generalized shock & hypovolemic shock
• May not show typical tachycardic response if on
Beta blockers, in heart block, or if bradycardic in
• May not show typical tachycardic response if on
Beta blockers, in heart block, or if bradycardic in
response to nodal tissue ischemia
• Mean arterial pressure below 70 mmHg
compromises coronary perfusion
– (MAP = SBP + (2) DBP/3)
38. Management Cardiogenic Shock
OPTIMIZING PUMP FUNCTION (CONT.):
– Morphine as needed (Decreases preload, anxiety)
– Cautious use of diuretics in CHF– Cautious use of diuretics in CHF
– Vasodilators as needed for afterload reduction
– Short acting beta blocker, esmolol, for refractory
tachycardia
39. Hemodynamic Goals of Cardiogenic
Shock
Optimized Cardiac function involves cautious
use of combined fluids, diuretics, inotropes,
vasopressors, and vasodilators to :
• Maintain adequate filling pressures (LVEDP 14• Maintain adequate filling pressures (LVEDP 14
to 18 mmHg)
• Decrease Afterload (SVR 800-1400)
• Increase contractility
• Optimize CO/CI
40. Therapy of low SV
• Drugs to move point back down curve: e.g..
GTN, diuretics, head-up posture
• Drugs to improve contractility: I.v.
inotropes, amrinone, ACE inhibitors
• Drugs to improve contractility: I.v.
inotropes, amrinone, ACE inhibitors
• Drugs to prevent fluid retention: ACE
inhibitors, diuretics
• Other methods: IABP, LVAD, heart
transplant
42. Dobutamine
• primarily a 1-receptor agonist (cardiac
stimulation), but it also has mild -2 effects
(vasodilation)
• causes a dose-dependent increase in stroke
volume
• decrease in cardiac filling pressures
• an alkaline pH inactivates catecholamines
such as dobutamine
• Dose 2-20 mcg/kg/min
43. Dobutamine
• dobutamine is the preferred inotropic agent for
the acute management of low output states due
to systolic heart failure. Because dobutamine
does not usually raise the arterial blooddoes not usually raise the arterial blood
pressure, it is not indicated as monotherapy
in patients with cardiogenic shock
44. Norepinephrine
• -receptor agonist that promotes widespread
vasoconstriction
• administration of any vasoconstrictor agent• administration of any vasoconstrictor agent
carries a risk of hypoperfusion and ischemia
involving any tissue bed or vital organ
• Dose 8-12 mcg/min
45. Distributive Shock
• Inadequate perfusion of tissues through
maldistribution of blood flow
• Intravascular volume is maldistributed• Intravascular volume is maldistributed
because of alterations in blood vessels
• Cardiac pump & blood volume are normal
but blood is not reaching the tissues
47. Anaphylactic Shock
• A type of distributive shock that results from
widespread systemic allergic reaction to an
antigenantigen
• This hypersensitive reaction is LIFE
THREATENING
48. Pathophysiology Anaphylactic
Shock
• Antigen exposure
• body stimulated to produce IgE antibodies
specific to antigen
– drugs, bites, contrast, blood, foods, vaccines
• Reexposure to antigen
– IgE binds to mast cells and basophils
• Anaphylactic response
49. Anaphylactic Response
• Vasodilatation
• Increased vascular permeability
• Bronchoconstriction• Bronchoconstriction
• Increased mucus production
• Increased inflammatory mediators
recruitment to sites of antigen interaction
51. Management Anaphylactic Shock
• Early Recognition, treat aggressively
•AIRWAY SUPPORT
• IV EPINEPHRINE (open airways)
• Antihistamines, diphenhydramine 50 mg IV• Antihistamines, diphenhydramine 50 mg IV
• Corticosteroids
• IMMEDIATE WITHDRAWAL OF ANTIGEN
IF POSSIBLE
• PREVENTION
52. Management Anaphylactic Shock
• Judicious crystalloid administration
• Vasopressors to maintain organ perfusion• Vasopressors to maintain organ perfusion
• Positive inotropes
• Patient education
53. NEUROGENIC SHOCK
• A type of distributive shock that results from the loss
or suppression of sympathetic tone
• Causes massive vasodilatation in the venous
vasculature, venous return to heart, cardiacvasculature, venous return to heart, cardiac
output.
• Most common etiology: Spinal cord injury above T6
•• Neurogenic is the rarest form of shock!Neurogenic is the rarest form of shock!
54. Pathophysiology of Neurogenic Shock
Distruption of sympathetic nervous system
Loss of sympathetic tone
Venous and arterial vasodilation
Decreased venous returnDecreased venous return
Decreased stroke volume
Decreased cardiac output
Decreased cellular oxygen supply
Impaired tissue perfusion
Impaired cellular metabolism
55. Assessment, Diagnosis and Management of
Neurogenic Shock
PATIENT ASSESSMENT
• Hypotension
• Bradycardia
• Hypothermia
MEDICAL
MANAGEMENT
• Goals of Therapy are to
treat or remove the cause
• Warm, dry skin
• RAP
• PAWP
• CO
• Flaccid paralysis below
level of the spinal lesion
treat or remove the cause
& prevent cardiovascular
instability, & promote
optimal tissue perfusion
56. MANAGEMENT OF
NEUROGENIC SHOCK
Hypovolemia- tx with careful fluid replacement for
BP<90mmHg, UO<30cc/hr
Changes in LOC
Observe closely for fluid overload
Vasopressors may be needed
Hypothermia- warming txs
-avoid large swings in pts body temperature
Treat Hypoxia
Maintain ventilatory support
57. MANAGEMENT OF
NEUROGENIC SHOCK
• Observe for Bradycardia-major
dysrhythmia
• Observe for DVT- venous pooling in
extremities make patients high-risk>>P.E.extremities make patients high-risk>>P.E.
• Use prevention modalities [TEDS,
ROM,Sequential stockings, anticoagulation]
NURSING DIAGNOSIS
• Fluid Volume Deficit r/t relative loss
• Decreased CO r/t sympathetic blockade
• Anxiety r/t biologic, psychologic or social
integrity
58. Management Neurogenic Shock
– Alpha agonist to augment tone if perfusion
still inadequate
• dopamine at alpha doses (> 10 mcg/kg per min)• dopamine at alpha doses (> 10 mcg/kg per min)
• ephedrine (12.5-25 mg IV every 3-4 hour)
– Treat bradycardia with atropine 0.5-1 mg
doses to maximum 3 mg
• may need transcutaneous or transvenous
pacing temporarily
59. Septic shock
• Syndrome of profound hypotension due to
release of endotoxins / TNF / vasoactive
peptides following bacterial destructionpeptides following bacterial destruction
• Usually associated with normal blood
volume, high / low CO, and low SVR
• Re-distribution of blood to splanchnic
vessels, with resultant poor skin perfusion
60. Pathophysiology of Septic shock
• Initiated by gram-negative (most common) or
gram positive bacteria, fungi, or viruses
Cell walls of organisms contain Endotoxins
Endotoxins release inflammatory mediatorsEndotoxins release inflammatory mediators
(systemic inflammatory response) causes…...
Vasodilation & increase capillary permeability
leads to
Shock due to alteration in peripheral circulation &
massive dilation
61. Clinical Presentation Septic
Shock
• Two phases:
– “Warm” shock - early phase
•• hyperdynamic response,hyperdynamic response,•• hyperdynamic response,hyperdynamic response,
VASODILATIONVASODILATION
– “Cold” shock - late phase
• hypodynamic response
• DECOMPENSATED STATE
62. Clinical Manifestations
• EARLY---HYPERDYNAMIC
STATE---COMPENSATION
– Massive vasodilation
– Pink, warm, flushed
– Decreased SVR
– Increased CO & CI– Pink, warm, flushed
skin
– Increased Heart Rate
Full bounding pulse
– Tachypnea
– Increased CO & CI
– SVO2 will be
abnormally high
– Crackles
63. Clinical Manifestations
• L ATE--HYPODYNAMIC
STATE--DECOMPENSATION
– Vasoconstriction
– Skin is pale & cool
– Increase SVR
– Decreased CO
– Significant tachycardia
– Decreased BP
–
– Decreased UOP
– Metabolic &
respiratory acidosis
with hypoxemia
64. COLLABORATIVE MANAGEMENT
• Prevention !!!
• Find and kill the source
of the infection
• Fluid Resuscitation
• Maximize O2 delivery
Support
• Nutritional Support• Fluid Resuscitation
• Vasoconstrictors
• Inotropic drugs
• Nutritional Support
• Comfort & Emotional
support
65. Initial management of septic
shock
• Administer pure oxygen
• Start I.v. line, and take bloods for culture
• Give 20ml/kg boluses of colloid• Give 20ml/kg boluses of colloid
• Observe rise in BP, CVP line if possible
• If > 60ml/kg (4200mL) consider ICU
referral
• Broad spectrum antibiotics urgently
66. ICU care of septic shock
• Adequate oxygenation and ventilation
• CVP and PA line
• Broad spectrum antibiotics• Broad spectrum antibiotics
• Drive oxygen delivery towards
600ml/min/m2
• Attempt to identify source of sepsis