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Shock Presentation
Shock Presentation
DAKOTA HORTON
SHOCK
Critical condition characterized by sudden drop in blood flow throughout the body
Circulatory system fails to maintain adequate blood flow
Fails to deliver oxygen and nutrients.
CLASSIFICATION OF SHOCK
Low Blood Flow
Cardiogenic shock
Hypovolemic shock
Absolute hypovolemia
Relative hypovolemia
CARDIOGENIC SHOCK
Decreased blood flow from compromised cardiac output
Systolic dysfunction
Inability of the heart to pump blood forward
Myocardial infarction
Cardiomyopathy
Blunt cardiac injury
Severe systemic or pulmonary hypertension
Diastolic dysfunction
Inability of the heart to fill during diastole
Pericardial tamponade
Dysrhythmias
Structural factors
Valvular abnormality: stenosis, regurgitation
Ventricular septal rupture
HYPOVOLEMIC SHOCK
Loss of intravascular fluid
Absolute hypovolemia
External loss of whole blood
Hemorrhage, trauma, surgery, GI bleeding
Relative Hypovolemia
Pooling of blood or fluids
Bowel obstruction
Fluid shifts
Burn injuries, ascites
Internal bleeding
Fracture of long bones, ruptured spleen, hemothorax, severe pancreatitis
Massive vasodilation
From sepsis
NEUROGENIC SHOCK
Hemodynamic consequence of spinal cord injury, disease or opioid overdose
massive vasodilation without compensation
caused by the loss of SNS vasoconstrictor tone
Or depression of the vasomotor center (from opioids, benzodiazepines)
Leads to a pooling of blood in the blood vessels, tissue hypoperfusion and impairment of
cellular metabolism
Can occur within 30 minutes of a spinal cord injury to T5 vertebrae or above and can last
up to 6 weeks
Important clinical manifestations
Hypotension
bradycardia
Inability to regulate temperature
ANAPHYLACTIC SHOCK
Life threatening hypersensitivity reaction to a substance
Immediate reaction
Massive vasodilation
Release of vasoactive mediators
Increase in capillary permeability
Fluid leaks from the vascular space into the interstitial space
SEPTIC SHOCK
Sepsis septic shock
Systemic inflammatory response to an infection
Infection stimulates extreme or exagerrated immune response
Patient experiences hypotension that cannot be reversed with fluid resuscitation, and
patients, malnourished patients, patients with diabetes mellitus, cancers, chronic kidney
disease and heart failure
STAGES OF SHOCK
Compensatory
Progressive
Refractory
Neurological Compensation
Baroreceptors in the carotid and aortic bodies activate the sympathetic nervous system
Stimulate the release of epinephrine and norepinephrine
Vasoconstriction
Blood flow to vital organs such as heart and brain is maintained
Blood flow to non vital organs and peripheries is reduced (kidneys, GI tract, skin, lungs)
Endocrine compensation
Decreased blood flow to the kidneys activates the renin-angiotension system
shock)
Decreased blood flow to the lungs results in physiological dead space. This dead space results in a
PROGRESSIVE STAGE
Progressive stage of shock begins as compensatory mechanism fail
Condition deteriorates, Blood pressure progressively falls
Aggressive interventions are necessary to prevent development of Multi Organ Dysfunction
Syndrome
Distinguishing features of this stage
Continued decreased cellular perfusion
Altered capillary permeability causing fluid to shift from vascular space into the interstitial space
Hypoperfusion
Pulmonary system first to display signs of dysfunction
Pulmonary vasoconstriction
Fluid shifts causing pulmonary interstitial edema
NURSING INTERVENTIONS
Early recognition and prompt interventions are required for successful management of
shock
Identify and treat underlying cause
Oxygen and ventilation as needed
Fluid resuscitation
Drug therapy
Sympathomimetic drugs
Vasodilators
SEPSIS SIX
What you can do within the first hour for atleast 6
hours
1) Give 100% oxygen
2) Take blood cultures to determine antibiotic therapy
3) IV antibiotics
4) IV fluid therapy
5) measure lactate and hemoglobin
6) Insert catheter and monitor urine output
Robson, W. P., & daniels, R. (2008). The sepsis six: Helping patient to survive sepsis. British Journal of Nursing, 17(1), 20.