SHOCK AND MULTI-ORGAN DYSFUNCTION

Shock

• is a life-threatening condition that results from inadequate tissue perfusion.

• tissue hypoperfusion prevents adequate oxygen delivery to cells, leading to cell dysfunction and death.

compensatory (stage 1)

progressive (stage 2)

irreversible (stage 3)

Stages of Shock

Compensatory stage

• Tachycardia, Tachypnea, Cool, pale skin

is the early stage of shock where the body activates compensatory mechanisms to maintain normal blood pressure and blood flow to vital organs.

Clinical Manifestations: (TTC)

Progressive stage

• Hypotension, confusion, lethargy

where the body's compensatory mechanisms fail, causing hypotension, worsening tissue hypoperfusion, and multiple organ dysfunction; is the second stage of shock.

Clinical Manifestations: (HCL)

irreversible/refractory stage

represents the point along the shock continuum at which organ damage is so severe that the patient does not respond to treatment and cannot survive

HYPOVOLEMIC SHOCK

CARDIOGENIC SHOCK

ANAPHYLACTIC SHOCK

NEUROGENIC SHOCK

OBSTRUCTIVE SHOCK

SEPTIC SHOCK

Types of Shock

Hypovolemic shock

• hypotension

• cool, pale, clammy skin

• oliguria

A life-threatening condition caused by severe loss of blood or body fluids, leading to inadequate tissue perfusion and oxygen delivery.

Cause: hemorrhage, severe vomiting/diarrhea, burns, dehydration, excessive fluid loss.

S/SX: (HCO)

Cardiogenic Shock

• angina

• arrhythmias

• fatigue

1. IV morphine

occurs when the heart’s ability to contract and to pump blood is impaired and the supply of oxygen is inadequate for the heart and the tissues

S/Sx: (AAF)

Treatment: __ for pain

intra-aortic balloon pump (IABP)

is a temporary device that improves cardiac output by inflating during diastole to increase coronary blood flow and deflating before systole to reduce the heart’s workload.

Anaphylactic shock

• Sudden hypotension with airway swelling/breathing difficulty (Hallmark)

• hives

• itching

Severe, life-threatening allergic reaction causing widespread vasodilation and airway compromise.

Causes: Foods, medications, insect stings, latex, or other allergens.

S/Sx: (SHI)

1. IM epinephrine

2. diphenhydramine

3. albuterol

Anaphylactic Shock

Medical Mgmt:

1. Give __ to restore vascular tone.

2. Give __ to reduce histamine effects.

3. Give __ for bronchospasm

Neurogenic shock

• Hypotension

• bradycardia

• warm, dry skin

A type of distributive shock caused by loss of sympathetic nervous system activity, leading to vasodilation and poor tissue perfusion.

Cause: Loss of sympathetic stimulation, commonly from spinal cord injury or spinal anesthesia.

Risk Factor: Spinal cord injury(high level), Spinal or epidural anesthesia, Severe nervous system trauma, Neurologic disorders affecting sympathetic function

S/Sx: (HBW)

Obstructive Shock

• Hypotension

• rapid heart rate

• shortness of breath

shock caused by physical obstruction of blood flow in the cardiovascular circulation

cause: Cardiac tamponade, tension pneumothorax, massive pulmonary embolism

Risk Factor: severe chest trauma, Pulmonary embolism, Tension pneumothorax, Cardiac tamponade, prolonged immobility

S/Sx: (HRS)

1. thrombolytic therapy

2. pericardiocentesis

3. needle decompression

Obstructive shock

Treatment

1. __ for pulmonary embolism

2. __ for cardiac tamponade

3. __ for tension pneumothorax.

Septic Shock

1. Suppressed Immune System; Extreme Age; People who’ve received an organ transplant; Surgical Procedure; Indwelling Devices; Sickness

• The most common type of distributive shock is caused by widespread infection or sepsis.

• A subset of sepsis in which underlying circulatory and cellular metabolism abnormalities are profound enough to substantially increase mortality

1. RISK FACTORS: (SEPSIS)

1. warm/flush skin, Fever, restless

2. cold/clammy skin Severe hypotension, hypothermia

Septic Shock Signs

1. Early: (WFR)

2. Late: (CSH)

Septic Shock Mgmt

(SEPTIC SHOCK)

Systemic Inflammatory Response Syndrome (SIRS)

1. Fever, Chills, Malaise, Weakness

• a type of cytokine release syndrome often referred to as a cytokine storm, results from a clinical insult that triggers a systemic inflammatory response rather than a localized one at the site of the insult.

• The insult may be a significant injury (e.g., multi trauma) or an infection (e.g., sepsis).

• A patient may be exhibiting a protective inflammatory response to the initiating insult or a response to infection that may lead to sepsis.

1. S/Sx: (FCMW)

• temperature (>38.3°C or <36°C)

• tachycardia

• tachypnea

• WBC count (>12,000 cells/mm3, < 4000 cells/mm3)

Clinical Criteria for SIRS

(TTTW)

Sepsis

• Hypotension

• Tachycardia

• Tachypnea

• SpO2 <92%

life-threatening organ dysfunction caused by a dysregulated host response to infection

S/Sx: (HTTS)

Septicemia

• high fever

• chills

• confusion

is a serious infection caused by bacteria entering the bloodstream, which can lead to sepsis and potentially result in organ damage or death. It is more prevalent in hospitalized individuals or those with pre-existing medical conditions and requires immediate medical attention and antibiotic treatment.

Risk Factors: severe wounds, age, and compromised immune systems

S/Sx: (HCC)

Septicemia Clinical Criteria

(PqM)

MULTIPLE ORGAN DYSFUNCTION SYNDROME (MODS)

1. Cardiovascular: Hypotension, decreased cardiac output

2. Metabolic: Hyperglycemia, increased metabolic demand

3. Renal: Increased creatinine, oliguria

4. Hepatic: Elevated bilirubin, impaired liver function.

5. Hematologic: Coagulopathy, thrombocytopenia

6. Neurologic: Confusion, decreased consciousness

is altered organ function in acutely ill patients that requires medical intervention to support continued organ function.

S/SX:

1. Cardiovascular: (HD)

2. Metabolic: (HI)

3. Renal: (IO)

4. Hepatic: (EI)

5. Hematologic: (CT)

6. Neurologic: (CD)

≥30°

In Neurogenic shock, elevate bed at __ with spinal/epidural anesthesia