Shock (Complications)

Complications of Shock (All Types)

• Anaerobic metabolism

  • Due to poor tissue perfusion

• This leads to a decrease in the amount of oxygen delivered to the cells

  • Resulting in anaerobic metabolism

  • Eventually leads to metabolic acidosis

Shock Complications (Brain)

• Decrease in blood flow to the brain leads to cerebral hypoxia

  • Can lead to either seizures or cerebral infarction

• Assess patient for:

  • Anxiety

  • Restlessness

  • Changes in LOC

  • Lethargy

  • Stupor

  • Coma

  • Seizures

Shock Complications (Kidneys)

• Vasoconstriction compromises the blood flow to the kidneys

  • Leads to acute tubular necrosis

• Assess the patient for:

  • Oliguria

  • Elevated BUN & Creatinine

Shock Complications (Myocardium)

• Decrease in CO leads to decreased coronary perfusion which leads to:

  • Myocardial failure

  • Altered cell membrane potential

  • Increased incidence of dysrhythmias

• Dysrhythmias can further decrease cardiac output

Shock Complications (Fluid SHift)

• Water moves into the cells taking sodium w/ it

• This movement of water further decreases the circulating blood volume

  • Leads to cellular edema & disruption of metabolic activity

Shock Complications (Peripheral Circulation)

• Initially there is a vasoconstrictive response in an attempt to increase circulating blood volume

• Fluid moves from the interstitial space to the intravascular space to restore volume

• Eventually the compensatory mechanisms fail

  • The body then attempts to maintain blood flow to the heart & the brain at the expense of the other organs

  • Shunting

Shock Complications (GI System)

• Blood vessels vasoconstrict

  • The bowels are affected more than any other system

  • Blood being shunted away from the bowel

• Leads to mucosal ischemia

  • May lead to stress ulcers

  • Bowel infarction

  • Ileus

• Assess patient for septic shock & listen to bowel sounds

Shock Complications (Hepatic System)

• Decreased blood flow to the liver leads to hepatic hypoxia

• May lead to:

  • Infection

  • Metabolic acidosis

  • Bleeding problems (DIC)

  • Decreased ability of the liver to get rid of toxins or to clear certain medications

Shock Complications (Glucose Metabolism)

• Patient may become hyperglycemic to meet increased demands of energy

Shock Complications (ARDS)

• Adult Respiratory Distress Syndrome (ARDS)

• Decreased blood flow to the lungs lead to

  • A decrease in the amount of surfactant that is produced

  • Leads to a collapse of the alveoli

• Increased capillary permeability

  • Fluid leaks from capillaries into the lungs causing pulmonary edema

Disseminated Intravascular Coagulation (DIC)

• Global inappropriate microcirculation clotting

• Paradoxical bleeding

• Occurs more in septic shock

DIC (Patho.)

• Inflammation that activates the coagulation system

• Consumes clotting factors

• Inappropriate microclotting all over the body

• Then leads to paradoxical bleeding

  • Eyes, ears, mouth, foley sites, gums, etc.

DIC (Causes)

• Trauma

• Shock

• Sepsis

• Cancer

• Toxins

• Allergic reaction

DIC (Assessment FIndings)

• Check skin

• Check labs

DIC (MODS)

• Multiple Organ Dysfunction Syndrome (MODS)

DIC (Lab Values)

• Platelets:

  • Decreased (All used up)

• D-Dimer:

  • Increased (Waste product of clotting)

• PT:

  • Increased (Clotting factors used up)

• PTT:

  • Increased (Clotting factors used up)

• TT (Thrombin Time):

  • Increased (Clotting factors used up)

• Fibrin:

  • Decreased (Used up for inappropriate clotting)

• FDP:

  • Increased (Waste product from clotting)

• Waste products trend up

  • Due to prolonged clotting times

DIC (Tx)

• Underlying cause

• Correct secondnary effects

• Replace what’s missing:

  • Volume

  • RBC

  • FFP

  • Clotting factors

• Heparin therapy

  • ONLY if we catch the clotting early

  • Do NOT give Heparin when they are already bleeding!!!

DIC (MODS)

• Multiple Organ Dysfunction Syndrome (MODS)

• 2 or more organs developed out of the initial site

• Ex:

  • Cardiogenic shock, then renal failure, then ARDS (Separate organs from the initial shock