lecture recording on 26 February 2025 at 13.17.18 PM

Stages of Shock

• Shock is a critical condition requiring urgent recognition and management.

Initial Stage of Shock

• Early stage of shock where patients may appear asymptomatic despite cellular changes.

• Occurs when patients have underlying conditions (e.g., infections, post-surgery).

  • Examples:

    • UTI from a Foley catheter.

    • Infections from surgical hardware or bowel surgery.

• Cellular Metabolism Changes:

  • Shift from aerobic to anaerobic metabolism due to lack of oxygen.

  • Leads to lactic acid buildup causing lactic acidosis.

• Significance of Lactic Acid:

  • Normally excreted by the liver, but in shock, the liver is compromised leading to further accumulation.

Compensatory Stage of Shock

• The body activates compensatory mechanisms to maintain homeostasis.

  • Increased heart rate and other physiological responses to meet oxygen needs (example: heart rate increases during physical exertion).

• Sympathetic Nervous System Activation:

  • Fight or flight response becomes predominant.

• Body's mechanisms for compensation:

  • Neuro, hormonal, and biochemical responses to manage decreased perfusion.

• Clinical Signs:

  • The patient may experience tachycardia, low blood pressure, and fever during this stage.

Progressive Stage of Shock

• If shock progresses, compensatory mechanisms begin to fail leading to serious complications.

• Clinical manifestations include:

  • Mental status changes.

  • Hemodynamic instability: Significant drops in blood pressure, increased heart rate.

  • Capillary Leak Syndrome: Results in fluid seeping into tissues leading to edema.

  • GI issues like stress ulcers due to low perfusion.

• Indicators for immediate intervention:

  • Low urine output, rising lactic acid levels, and changes in blood chemistry (e.g., CRP).

Refractory Stage of Shock

• Final and most severe stage, often leading to multiple organ dysfunction syndrome (MODS).

• Signs include:

  • Profound hypotension despite treatment.

  • Decline in respiratory and renal function.

• Patients may require extensive interventions such as mechanical ventilation.

• High mortality rate associated with this stage.

Treatment and Management of Shock

Early Recognition

• Vital to promptly diagnose and treat shock to improve patient outcomes.

• Identify and eliminate the underlying cause of shock.

Fluid Management

• Fluid Replacement:

  • Isotonic fluids (e.g., Normal saline, Lactated Ringer's) are critical in managing hypovolemic and septic shock.

• Monitor for:

  • Fluid overload (e.g., signs of edema, crackles in lungs).

  • Use of the Frank-Starling curve to assess fluid responsiveness.

Pharmacologic Interventions

• Vasopressors may be initiated if fluid resuscitation is insufficient to maintain blood pressure:

  • Common examples include norepinephrine and vasopressin.

• Do not overload patients with fluids in cases of cardiogenic shock.

Monitoring Parameters

• Regular assessments of vital signs:

  • Blood pressure, heart rate, urine output.

  • Lactic acid levels act as a key indicator of perfusion status.

• Utilize diagnostic tools:

  • Central venous pressure monitoring (CVP) to manage hemodynamics.

Patient Care Post-Shock

• Supportive Care:

  • Emotional and psychological support due to the trauma experienced during shock.

  • Educate about prevention strategies to reduce fear of recurrence.

• Focus on long-term health improvements and monitoring to prevent future episodes.