Shock (Hypotension)

Van Meter & Hubert, Chapter 12 (pp. 264-269), Adams et al., Chapter 58 pg. 741-746

 results from a decreased circulating blood volume, leading to decreased tissue perfusion and
general hypoxia
 cardiac output is low

Refer to Table 12-4 on page 265 (Van Meter & Hubert 5 th ed.) for the classification of shock according
to cause.

Pathophysiology
Review the physiology of blood pressure.
 define blood pressure
 define systolic blood pressure
 define diastolic blood pressure
 blood pressure depends on ____________________ and _________________________.

Identify 3 factors that are important in the maintenance of blood

1. …………………………………………..
2. …………………………………………..
3. …………………………………..........

Explain 2 ways in which the sympathetic nervous system elevates the blood pressure.

Explain how each of the following contributes to the control of blood pressure:
a) antidiuretic hormone

b) aldosterone

c) renin-angiotensin-aldosterone system

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Study the progress of shock, using the flowchart in Van Meter & Hubert, Figure 12-35 on page 267 in
5th ed.

2
Refer to Figure 12-34 on page 266 in 5th ed. in Van Meter & Hubert to relate these factors to the
occurrence of hypovolemic, cardiogenic and neurogenic shock.

Etiology
Hypovolemic shock
 loss of blood or plasma from the circulating blood volume, such as occurs in dehydration;
peritonitis (results in loss of fluid to the peritoneal space = third-spacing), burns

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Cardiogenic shock
 cardiac impairment, such as occurs in arrhythmias, acute infarction of the left ventricle

Vasogenic shock (also referred to as distributive shock) - there is increase capacity of the vascular
system causing a decrease in peripheral vascular resistance (PVR)

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 a) neurogenic or vasogenic shock
 may develop from pain, fear, drugs, or loss of sympathetic nervous system stimuli with spinal
cord injury, hypoglycemia, insulin shock
b) anaphylactic shock
 results from rapid general vasodilation due to the release of large amounts of histamine in a
severe allergic reaction
Septic shock
 may develop in the presence of severe infection, particularly with endotoxins of gram-negative
organisms, such as E. coli or pseudomonas
 systemic vasodilation occurs

Signs and Symptoms – refer to Figure 12-36 on page 268 in 5 th ed. and Table 12-5 page 269 in 5th ed.
Sign/symptoms Pathophysiology
Early signs Thirst and agitation or restlessness

Compensatory Cool, moist, pale, skin

stage- the body
activates neural, Tachycardia
hormonal and
biochemical Oliguria
compensatory
mechanisms to Thirst
maintain
homeostasis Rapid respirations (tachypnea)

Lethargy, weakness, dizziness

Decompensation Stupor, confusion

Acute renal failure (anuria)

Arrythmias

Paralytic ileus

Metabolic acidosis (uncompensated)

Drugs used to treat shock

 depends on the cause of shock
 hypovolemic – whole blood, plasma or fluid with electrolytes and bicarbonate
 anaphylactic – antihistamines and corticosteroids
 septic – antimicrobials and glucocorticoids

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Fluid replacement agents
A) Blood products
 whole blood used for:
 acute, massive blood loss
 replacement of plasma volume
 supplying red blood cells to increase the oxygen-carrying capacity of the
blood
 whole blood has been generally replaced now with components of blood,
such as plasma proteins, fresh frozen plasma and packed red blood cells

B) Colloids
 proteins or other large molecules that stay suspended in the blood for long periods of
time because they are too large to cross the cell membrane
 have an ability to increase oncotic pressure and so draw water from cells into the blood
vessels
 blood products include serum albumin, plasma protein fraction, and serum globulins
 non-blood products include dextran

C) Crystalloids
 IV solutions that contain electrolytes in concentrations resembling those of plasma
 can readily leave the blood and enter the cells
 used to replace fluid loss and to promote urine output
 include normal saline, hypertonic saline, Ringer’s lactate, and 5% dextrose in water