Shock

How does perfusion apply to cardiogenic shock?

there is a decrease in perfusion because the heart is failing to pump efficiently, this causes less fluid to be perfused through the body.

How does perfusion apply to hypovolemic shock?

there is a decrease in perfusion because of loss of intravascular volume (fluid or blood).

How does perfusion apply to distributive/vasogenic shock?

decrease in perfusion due to widespread vasodilatation that leads to decreased blood flow to organs.

What is the pathophysiology with cardiogenic shock following an MI?

cardiogenic shock usually follows an anterior wall infarction which leads to the heart being unable to pump

What is the initial stage of shock?

occurs when there is hypo perfusion in the body. there are usually no obvious signs and symptoms. During this stage the body is compensating okay and it can be reversed.

What is the compensatory stage of shock?

This stage occurs when there is a sustained reduction in tissue perfusion. symptoms become apparent and it presents as

hyperventilation(RESP ALK), high HR, low BP, high blood sugars and changes in LOC. diminished bowel sounds, oliguria, think neuro, endocrine, chemical

constriction/bronchdialation

What is the progressive stage of shock?

This stage begins when compensatory mechanisms begin to fail and the body starts shunting blood to the vital organs (brain, heart, lungs).

This presents as edema, dysrhythmias, low BP with narrow pulse pressure, tachypnea, cold/clammy skin, molting, absent bowel sounds, lethargy. metabolic and respiratory acidosis.

bun, creat, k+ high

What is the refractory stage of shock?

This stage of shock is usually not reversible. organs begin to fail and we see presentation as dysrhythmias, cerebral changes, hepatic dysfunction pt becomes unresponsive, basically everything is shutting down. MODS + SIRS (systemic inflammatory response syndrome)

what causes hypovolemic shock

hemorrhage, trauma, surgery, vomiting, diarrhea, burns, anything that causes a major blood or fluid loss.

hemodynamics of hypovolemic shock

high HR, High RR, High SVR,flat neck veins,

low BP, low CPV, low cvp, low CO, low SVR, low UO, AMS, low SVo2

hypovolemic shock treatment

Treat the cause

1. Lower the HOB (put the head LOW in HYPOtension)

2. Fluid replacement, Give blood or crystalloids (NS/LR)

3. vasopressors to increase BP (epi/norepinephrine) , we want MAP to be sustained between 60-70.

causes of cardiogenic shock

MI, cardiomyopathy, myocarditis, severe HF.

cardiogenic shock hemodynamics

HIGH HR, CVP, WEDGE, SVR

Low BP, CO.CI

treatment for cardiogenic shock

-promote contractility.

-decrease myocardial O2 demand by providing supplemental O2 and Balloon pump

-positive inotropic=more forceful beats

-Dopamine, dobutamine, primacor

-give diuretics (lasix or vasodilators) (depending on BP)

what is cardiogenic shock

results when an inefficient heart cannot sustain adequate circulation

What is obstructive shock?

Conditions that obstruct the blood flow, decrease the perfusion and cause shock

What causes obstructive shock?

tension pneumo, cardiac tamponade, any compression of the great veins, pericarditis, impaired diastolic filling.

obstructive shock hemodynamics

low BP, high HR, high CVP, high PAWP, High SVR

, low CO, low SVO2, low CI

obstructive shock treatment

remove obstruction, centesis, anticoagulation, emergency decompression

what is neurogenic shock

loss of vascular tone and peripheral pooling of blood from spinal cord injury. DISTRIBUTIVE SHOCK

What causes neurogenic shock?

imbalance between sympathetic and parasympathetic stimulation, direct or indirect insults to the neuro system, spinal cord injuries.

neurogenic shock hemodynamics

all is low or normal low

neurogenic shock treatment

Hemodynamic stabilization:

careful fluid resuscitation, vasopressors to maintain BP and organ perfusion, treat bradycardia and hypothermia, DVT prophylaxis

what is anaphylactic shock?

an extreme, often life-threatening allergic reaction to an antigen to which the body has become hypersensitive. DISTRIBUTIVE SHOCK

what causes anaphylactic shock?

allergies to food, bugs, meds, ect.

anaphylactic shock hemodynamics

high HR, dysrhythmias, normal or low BP/CO/CI/CVP/PAWP/SVR

anaphylactic shock treatment

epinephrine, Benadryl, histamine blocking agents (ranitidine) corticosteroids

what is septic shock?

a life-threatening condition caused by an overwhelming inflammatory response. DISTRIBUTIVE SHOCK

What causes septic shock?

immunosuppression and bacteremia

septic shock hemodynamics

high HR, high RR, low BP, temp can be high or low, widened pulse pressure, high CO, high CI,

low CVP, low PAWP, low SVR, low MAP

treatment for septic shock

Fluids + vasopressors, antibiotics in the hour,, timely identification, control BG

pressors if sbp <90, or map <65 after fluid bolus

how does an acute MI relate to cariogenic shock?

left ventricular failure

Causing ineffective pumping due to decreased contractility and fluid overload.

s/s of both cariogenic shock snd acute MI

hypoxemia + dyspnea

MODS (multiple organ dysfunction syndrome)

progressive failure of 2 or more organs

DIC (Disseminated intravascular coagulation)

MODS can lead to DIC

with DIC the body produces micro clots which leads to ischemia + bleeding

EXCHANGE happens in

capillaries

capillaries have a

high surface area for O2 and nutrient exchange

no contractile ability

precapillary sphincter regulates

flowcon

contriction diverts

blood flow

what is produced less?

ATP

How to fix progressive stage

fluids, cosntriction/bronchodialation

MCS- balloon

inflates to give counterpulsation to help perfusion, decreased afterload, increase CO SV

obstructive-what increased RV afterload

PE, pulm HTN, increased throacic

obstructive-what increased LV afterload

aortic disection, aortic stenosis

obstructive- impaired diastolic filling causes

tamponade, Tension pneumo, pericarditis

what meds can cause neuro shock

barbits, phenthiazines, sympathetics blocking